Characterization of Pancreatic Tumors with Quantitative Perfusion Analysis in Contrast-Enhanced Harmonic Endoscopic Ultrasonography

Abstract

Objectives: This study evaluated whether quantitative perfusion analysis with contrast-enhanced harmonic (CH) endoscopic ultrasonography (EUS) characterizes pancreatic tumors, and compared the hemodynamic parameters used to diagnose pancreatic carcinoma. Methods: CH-EUS data from pancreatic tumors of 76 patients were retrospectively analyzed. Time-intensity curves (TIC) were generated to depict changes in signal intensity over time, and 6 parameters were assessed: baseline intensity, peak intensity, time to peak, intensity gain, intensity at 60 s (I₆₀), and reduction rate. These parameters were compared between pancreatic carcinomas (n = 41), inflammatory pseudotumors (n = 14), pancreatic neuroendocrine tumors (n = 14), and other tumors (n = 7). All 6 TIC parameters and subjective analysis for diagnosing pancreatic carcinoma were compared. Results: Values of peak intensity and I₆₀ were significantly lower and time to peak was significantly longer in the groups with pancreatic carcinomas than in the other 3 tumor groups (p < 0.05). Reduction rate was significantly higher in pancreatic carcinomas than in pancreatic neuroendocrine tumors (p < 0.05). Areas under the receiver-operating characteristic curves for the diagnosis of pancreatic carcinoma using subjective analysis, baseline intensity, peak intensity, intensity gain, I₆₀, time to peak, and reduction rate, were 0.817, 0.664, 0.810, 0.751, 0.845, 0.777, and 0.725, respectively. I₆₀ was the most accurate parameter for differentiating pancreatic carcinomas from the other groups, giving values of sensitivity/specificity of 92.7/68.6% when optimal cutoffs were chosen. Conclusions: In pancreatic carcinomas, TIC patterns were markedly different from the other tumor types, with I₆₀ being the most accurate diagnostic parameter. Quantitative perfusion analysis is useful for differentiating pancreatic carcinomas from other pancreatic tumors.

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

“…CE-EUS-depicted hypervascular enhancement diagnoses neuroendocrine tumors with a sensitivity and specificity of 78.9% (61.4%-89.7%) and 98.7% (96.7%-98.8%), respectively. The recent development of software for TIC analysis enables some degree of quantitative assessment [198][199][200][201].…”

Value of contrast‐enhanced harmonic endoscopic ultrasonography with enhancement pattern for diagnosis of pancreatic cancer: A meta‐analysis

“…Contrast‐enhanced harmonic EUS (CH‐EUS) with second‐generation contrast agents is considered an accurate technique for investigation of pancreatic lesions. In fact, the utility of CH‐EUS for the differential diagnosis of pancreatic lesions has been reported in many studies …”

“…In fact, the utility of CH-EUS for the differential diagnosis of pancreatic lesions has been reported in many studies. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Two meta-analyses were previously published on the use of CE-EUS for the diagnosis of pancreatic lesions; 21,22 however, these reports included CE-Doppler EUS and firstgeneration contrast agents. Therefore, we carried out a metaanalysis on the diagnosis of pancreatic cancer using current state-the-art CH-EUS techniques.…”

Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Early Diagnosis of Small Pancreatic Cancer

“…The following are potential reasons for these results: (1) EUS is superior to any other modality with respect to spatial resolution; and (2) EUS allows for dynamic and repeated examinations in an area suspected be pancreatic cancer. However, CH-EUS is superior to conventional EUS, and its utility for the differential diagnosis of pancreatic lesions has been reported in many studies [7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], as most pancreatic solid lesions are depicted as a hypoechoic mass in conventional EUS regardless of histology. Therefore, we used CH-EUS in the differential diagnosis for pancreatic lesions.…”