Power Doppler Endoscopic Ultrasonography for the Differential Diagnosis Between Pancreatic Cancer and Pseudotumoral Chronic Pancreatitis

Abstract

Power Doppler EUS provides useful information for the differential diagnosis of pancreatic masses. The results were in concordance with previous studies that showed a hypovascular pattern of pancreatic carcinoma, as well as the formation of collaterals in advanced cases due to the invasion of the splenic or portal veins. Further studies of dynamic EUS with contrast agents are necessary to better characterize pancreatic masses.

Mesenteric venous collateral vessels mimicking cystic pancreatic neoplasm

“…Evaluating a pancreatic lesion with colour and power Doppler sonography before FNA or biopsy may be crucial, as biopsy of one of these vascular channels has the potential to result in catastrophic haemorrhage. Although few reports highlight the utility of EUSDoppler in differentiating chronic pancreatitis from carcinoma [2,3], to our knowledge, there are no reports of true intrapancreatic benign mesenteric venous collateral vasculature diagnosed with EUS.…”

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

“…Hypoenhancement on CEUS is considered suggestive of adenocarcinoma, due to the presence of a high proportion of desmoplastic tissue within the tumors, with few microvessels. Using a high mechanical index and Doppler CEUS, the hypovascular aspect was suggestive of adenocarcinoma in 83-94% of patients [88,[90][91][92][93][94]. Motion artifacts and blooming effect are frequent, however, and this method has been replaced by harmonic CEUS.…”

The Role of Endoscopic Ultrasound to Diagnose, Exclude or Stablish the Parenchimal Changes in Chronic Pancreatitis

“…Several techniques associated with EE have been described for this purpose. The use of Echo-guided Power Doppler for differential diagnosis showed sensitivity and specificity of 93% and 77% respectively (35). The use of contrast agent (Sonovue) seems to increase sensitivity and specificity rates to 91% compared to EE alone versus 73% and 93% vs. 83%, respectively (36).…”

“…The use of contrast agent (Sonovue) seems to increase sensitivity and specificity rates to 91% compared to EE alone versus 73% and 93% vs. 83%, respectively (36). Echo-guided elastography also contributes for diagnosis, but studies are still preliminary and need further confirmation (35).…”

“…This diagnosis is relatively difficult to make and an accurate diagnosis could avoid unnecessary surgical treatment (35). Several techniques associated with EE have been described for this purpose.…”