Novel quantitative perfusion analysis with contrast-enhanced harmonic EUS for differentiation of autoimmune pancreatitis from pancreatic carcinoma

Imazu, Hiroo; Kanazawa, Keisuke; Mori, Naoki; Ikeda, Keiichi; Kakutani, Hiroshi; Sumiyama, Kazuki; Hino, Shoryoku; Ang, Tiing Leong; Omar, Salem; Tajiri, Hisao

doi:10.3109/00365521.2012.679686

Cited by 82 publications

(63 citation statements)

References 40 publications

(49 reference statements)

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“…Kasono et al found that CHEUS with Levovist improved the preoperative localization of insulinomas 12 . Imazu et al used another sonographic contrast agent Sonazoid and found that the depth of invasion of biliary cancer and vascular invasion of pancreatic and biliary cancer could be demonstrated more clearly with CHEUS compared to EUS 6 . CHEUS with Sonazoid was found to be useful in differentiating pancreatic cancer from chronic pancreatitis in a more recent study 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Preliminary studies showed that second generation contrast agents such as Sonovue 4 and Sonazoid 5 improved T staging of pancreatic tumors. Sonazoid was also useful for differentiating pancreatic cancer from chronic pancreatitis 6 . DEFINITY™ (Lantheus Medical Imaging, Massachusetts, United States of America) is a second generation contrast agent made of perfluopentane surrounded by a phospholipid outer shell commonly used in contrast echocardiography 7 .…”

Section: Introductionmentioning

confidence: 99%

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A pilot study of contrast harmonic endosonography using DEFINITY™ in the evaluation of suspected pancreatic and peri-ampullary malignancies

Teo¹,

Ang²,

Kwek³

et al. 2011

jig

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Aim: contrast harmonic endosonography (cheUs) is not widely available. This study assessed the utility of cheUs using DeFINITY™, a second generation ultrasonic contrast agent, in the evaluation of suspected pancreatic and peri-ampullary malignancies. Methods: prospectively enrolled patients with suspected pancreatic and peri-ampullary malignancies underwent eUs followed by cheUs. The incremental yield of cheUs over eUs was analyzed. The gold standard for diagnosis of malignancy was positive cytology or histology; a negative diagnosis for malignancy was based on negative cytology or histology and benign clinical course. Results: Twenty-nine patients were enrolled and underwent cheUs. The final diagnoses were: pancreatic adenocarcinoma (16/29); metastases to pancreas (4/29); pancreatitis with inflammatory mass (4/29); normal pancreas with focal fat sparing (1/29); ampulla adenocarcinoma (2/29); serous cystic neoplasm (1/29); peri-pancreatic lymph node due to lymphoma (1/29). One bengin case of chronic pancreatitis had calcification casting artifacts that prevented accurate eUs examination and was excluded, leaving 28 cases for comparative analysis between eUs and cheUs. cheUs enhanced tumor margins. cheUs detected vascular invasion missed by eUs in 2/16 patients with pancreatic adenocarcinoma. Masses appeared hypoechoic with eUs. With cheUs malignant masses had an inhomogeneous hypoechoic pattern associated with abnormal vessels while lesions due to focal pancreatitis or fat sparing were characterized by diffuse enhancement (p<0.001). Conclusion: cheUs improved the visualization of tumor margins and vascular invasion, and differentiated benign from malignant masses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A pilot study of contrast harmonic endosonography using DEFINITY™ in the evaluation of suspected pancreatic and peri-ampullary malignancies

Teo¹,

Ang²,

Kwek³

et al. 2011

jig

Self Cite

View full text Add to dashboard Cite

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“…The reported sensitivity, specificity, and accuracy of EUS with a TIC were 95.8%, 92.6%, and 94.7%, respectively. In 2012, Imazu et al reported that peak intensity and maximum intensity gain were significantly higher for AIP than for PC 25) . In 2015, Saftoiu et al described TIC analysis with an artificial neural network classification model for diagnosing PC and chronic pancreatitis 52) .…”

Section: Quantitative Evaluation Of Ch -Eus For Splsmentioning

confidence: 99%

Contrast-enhanced harmonic endoscopic ultrasonography in gallbladder cancer and pancreatic cancer

Sugimoto

Takagi

Suzuki

et al. 2017

FJMS

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Endoscopic ultrasonography (EUS) plays a major role in diagnosing gallbladder (GB) cancer and pancreatic cancer (PC). In cases of GB cancer, EUS allows for precise observations of morphology and wall layers. However, proficiency is required for the morphologic diagnosis of GB tumors. Therefore, contrast -enhanced harmonic EUS (CH -EUS) began to be performed to diagnose GB lesions. CH -EUS enables real -time observation of the hemodynamics of GB tumors. The enhanced patterns generated by CH -EUS improve precision in the diagnosis of such tumors. PC appears as a hypoechoic mass on EUS. However, distinguishing between PC and mass -forming pancreatitis or focal autoimmune pancreatitis (AIP) is difficult via conventional EUS. CH -EUS allows for differentiating among these diseases (PC is hypoenhanced and heterogeneously enhanced, pancreatitis is isoenhanced, and a pancreatic neuroendocrine tumor is hyperenhanced). EUS -guided fine needle aspiration (EUS -FNA) also contributes to pathological diagnoses of pancreatic lesions. However, certain PC patients cannot be diagnosed via EUS -FNA. PC is heterogeneously enhanced on CH -EUS, and unenhanced regions have been reported to be areas of fibrosis or necrosis. CH -EUS -guided fine needle aspiration (CH -EUS -FNA) permits puncturing of the enhanced area while avoiding necrotic and fibrotic regions. Moreover, as CH -EUS findings have been quantitatively analyzed, a time -intensity curve (TIC) has become usable for diagnosing solid pancreatic lesions. CH -EUS -related techniques have been developed and increasingly utilized in the pancreaticobiliary area.

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“…Nevertheless, the deposition of C3c and IgG in the basement that enhancement of the pancreatic parenchyma is repressed during the arterial to parenchymal phase and is recovered at the portal phase to delayed phase [39] . This enhancement pattern is distinct from that of PC and is applied to contrast-enhanced EUS for the differentiation of AIP and cancer by analyzing time-intensity curves [40,41] . Typically, a linear or band-like structure, depicted as low density by computed tomography (CT) and a hypo-intensity signal by T2-weight magnetic resonance image (MRI), appears at the margin of the enlarged pancreatic parenchyma and is referred to as a "capsule-like rim", reflecting the fibrous tissue [39,42] .…”

Section: Type 2 Aipmentioning

confidence: 99%

Diagnosis Autoimmune Pancreatitis

Hart¹,

Chari²

The Pancreapedia: Exocrine Pancreas Knowledge Base

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Autoimmune pancreatitis (AIP) is a distinct form of chronic pancreatitis that is increasingly being reported. The presentation and clinical image findings of AIP sometimes resemble those of several pancreatic malignancies, but the therapeutic strategy differs appreciably. Therefore, accurate diagnosis is necessary for cases of AIP. To date, AIP is classified into two distinct subtypes from the viewpoints of etiology, serum markers, histology, other organ involvements, and frequency of relapse: type 1 is related to IgG4 (lymphoplasmacytic sclerosing pancreatitis) and type 2 is related to a granulocytic epithelial lesion (idiopathic duct-centric chronic pancreatitis). Both types of AIP are characterized by focal or diffuse pancreatic enlargement accompanied with a narrowing of the main pancreatic duct, and both show dramatic responses to corticosteroid. Unlike type 2, type 1 is characteristically associated with increasing levels of serum IgG4 and positive serum autoantibodies, abundant infiltration of IgG4-positive plasmacytes, frequent extrapancreatic lesions, and relapse. These findings have led several countries to propose diagnostic criteria for AIP, which consist of essentially similar diagnostic items; however, several differences exist for each country, mainly due to differences in the definition of AIP and the modalities used to diagnose this disease. An attempt to unite the diagnostic criteria worldwide was made with the publication in 2011 of the international consensus diagnostic criteria for AIP, established at the 2010 Congress of the International Association of Pancreatology (IAP).

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Novel quantitative perfusion analysis with contrast-enhanced harmonic EUS for differentiation of autoimmune pancreatitis from pancreatic carcinoma

Abstract: Pancreatic mass lesions of AIP and PC exhibited markedly different patterns with the TIC. This novel diagnostic modality using TIC generated by CH-EUS might offer an opportunity to improve accuracy in the differential diagnosis between pancreatic mass lesion of AIP and PC.

Cited by 82 publications

References 40 publications

A pilot study of contrast harmonic endosonography using DEFINITY™ in the evaluation of suspected pancreatic and peri-ampullary malignancies

A pilot study of contrast harmonic endosonography using DEFINITY™ in the evaluation of suspected pancreatic and peri-ampullary malignancies

Contrast-enhanced harmonic endoscopic ultrasonography in gallbladder cancer and pancreatic cancer

Diagnosis Autoimmune Pancreatitis

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