Modern ultrasound imaging of pancreatic tumors

Abstract

In patients with solid pancreatic lesions (SPLs), the differential diagnosis must be evaluated to determine whether radical surgery, pancreatic parenchyma-saving strategies, or follow-up is indicated. Contrast-enhanced (endoscopic) ultrasonography and elastography facilitate the further characterization of SPLs. The majority of cases of pancreatic ductal adenocarcinoma exhibit hypoenhancement with contrast-enhanced ultrasonography. Elastographically soft SPLs are benign with very few exceptions, whereas stiffer SPLs can be malignant or benign. This article reviews the current use of modern ultrasound imaging techniques, including contrast-enhanced ultrasonography and elastography, for the detection and characterization of SPLs. In particular, the unexcelled diagnostic potential of multiparametric endoscopic ultrasonography to detect and characterize small SPLs is highlighted.

Do we need elastography for EUS?

“…Modification of presets, diameter of the lesion, as well as the elasticity of the lesion surrounding tissue may influence the results of elastography significantly. [ 65 66 67 68 ] Qualitative elastography using scoring systems is prone to subjective assessment, and cutoff values for strain ratio differ a lot between studies. Moreover, compression by the transducer can artificially increase the strain,[ 3 14 ] and in some anatomical positions, compression induced by physiological pulsations of the heart and large arterial vessels is not sufficient to create stable elastography images.…”

Update in Contrast-Enhanced Ultrasound

“…Differential diagnostic difficulties arise for transabdominal CEUS in the small microcystic serous neoplasia, which, due to the microcystic structure, can simulate a hypervascularized tumor. The endosonographic representation as ECEUS can dissolve the angioarchitecture and is therefore helpful in delimitation of solid hypervascularized nodes [25].…”

“…Fig. 7), neuroendocrine tumors are vascularized and hypervascularized compared to the parenchyma of the pancreas [24, 25]. If B-scan and CEUS speak for adenocarcinoma, fanning out of the liver, which can be carried out at the same time, helps to find distant metastases.…”

Intraoperative Characterization of Pancreatic Tumors Using Contrast‐Enhanced Ultrasound and Shear Wave Elastography for Optimization of Surgical Strategies

“…3,[11][12][13][14][15][16] Studies of recent literature proved this advantage of SWE, particularly for small FPLs. 14,17,18 Another important feature that helps distinguish malignant from benign FPLs is their microvascularization. Dynamic visualization of FPLs' microvascularization can be performed well with CEUS.…”

“…Nevertheless, percutaneous applications of CEUS have already proven to be successful concerning typical intraoperative questions such as extension of an FPL, differentiation of malignant and benign lesions, and determining resection margins. 2,17,19,26 In this study, we wanted to evaluate whether a transfer of experience gained from hepatic applications to pancreatic IoUS using intraoperative shear wave elastography (IoSWE) and IoCEUS is possible. Thereby, we wanted to contribute to improved pancreatic tumor resection using modern US techniques.…”