Differentiation of Pancreatic Tumours by Conventional Ultrasound, Unenhanced and Echo-Enhanced Power Doppler Sonography

Rickes, Steffen; Unkrodt, K; Neye, Holger; Ocran, K; Wermke, Wolfram

doi:10.1080/003655202761020605

Cited by 122 publications

(82 citation statements)

References 17 publications

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“…The variation in this study in comparison with Fusaroli et al [57] may have occurred because more patients with severe chronic pancreatitis were enrolled in the Fusaroli et al [57] study, which may have altered the enhanced pattern of pancreatic adenocarcinomas. Severe forms of chronic pancreatitis mean less intense intralesional "parenchymographic" enhancement and fibrosis resulting in decreasing vascular flow [62][63][64] . [65] compared the aforesaid QE-EUS to CEH-EUS.…”

Section: The Role Of Eus As Palliative Treatment Of Pancreatic Cancermentioning

confidence: 99%

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

Gonzalo-Marin¹

2014

WJGO

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Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography (CT) and transabdominal ultrasound for recognising early pancreatic tumors. As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer. The complication rate of EUS is as low as 1.1%-3.0%. New technical developments such as elastography and the use of contrast agents have recently been applied to EUS, improving its diagnostic capability. EUS has been found to be superior to the recent multidetector CT for T staging with less risk of overstaying in comparison to both CT and magnetic resonance imaging, so that patients are not being ruled out of a potentially beneficial resection. The accuracy for N staging with EUS is 64%-82%. In unresectable cancers, EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block, biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy. Key words: Endosonography; Pancreatic neoplasms; Endoscopy; Diagnosis; Neoplasm Staging; Therapeutics Core tip: In this article, the role of endoscopic ultrasonography as a diagnostic, staging and therapeutic procedure in patients with pancreatic cancer is discussed and all the current knowledge on this subject is summarized, providing the reader with a quick update.Gonzalo-Marin J, Vila JJ, Perez-Miranda M. Role of endoscopic ultrasound in the diagnosis of pancreatic cancer. World J Gastrointest Oncol 2014; 6(9): 360-368 Available from: URL:

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Section: The Role Of Eus As Palliative Treatment Of Pancreatic Cancermentioning

confidence: 99%

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

Gonzalo-Marin¹

2014

WJGO

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“…The most effective imaging techniques for the detection of PaC are multidetector computer tomography (CT) and endoscopic ultrasonography (EUS) (21). The sensitivity of transabdominal ultrasonography (US) in the diagnosis of PaC is only 50-70% (22). However, US is easy to use, widely available, non-invasive and relatively inexpensive, making it an ideal screening modality.…”

Section: Introductionmentioning

confidence: 99%

New-onset type 2 diabetes mellitus – A high-risk group suitable for the screening of pancreatic cancer?

et al. 2016

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2Background: Type 2 diabetes mellitus is widely considered to be associated with pancreatic cancer.Objective: To determine the incidence of pancreatic cancer in new-onset type 2 diabetic patients by measuring the serum level of CA 19-9 and performing abdominal ultrasonography (US). Patients and Methods:Consecutive type 2 diabetic patients in whom diabetes was diagnosed within 36 months were included in this prospective study. Serum CA 19-9 measurement and US were performed in all patients. If any of two was positive, abdominal computer tomography (CT) was carried out. Endoscopic ultrasound-guided fine needle aspiration or direct surgical referral was performed on patients with CT-identified lesions.Results: A total of 115 patients were enrolled. CA 19-9 was elevated in 10 patients but pancreatic cancer diagnosed in neither of them. Pancreatic cancer was revealed by morphological means in three patients without elevated CA 19-9 level. The sensitivity, specificity, positive-, negative predictive values and validity were 0%, 90.4%, 0%, 97.9% and 87.9% for CA 19-9, 66.7%, 100%, 100%, 99% and 99% for US, respectively. The value of the Standardized Incidence Ratio for pancreatic cancer in new-onset type-2 diabetic patients was 198.6 (95% CI=6.25-46.9). Conclusions:The prevalence of pancreatic cancer in patients with new-onset type-2 diabetes is significantly higher than that in the general population and screening is beneficial for detecting PaC in this patient population. CA 19-9 and US is not reliable screening modality for pancreatic cancer screening in this population.

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“…It consists of sulfur hexafluoride filled microbubbles which are surrounded by a shell composed of a phospholipidic monolayer. [12][13][14][15][16][17][18] The use of an echo enhancer increases the Doppler signal, which is generated by destroying the microbubbles. Echo enhanced ultrasound employs the so-called pulse inversion process, in which two ultrasonic waves that are 180˚out of phase with each other are transmitted into the tissue under examination, one shortly after the other.…”

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confidence: 99%

Echo-enhanced ultrasound – A new valid initial imaging approach for severe acute pancreatitis

Rickes¹,

Uhle²,

Mönkemüller³

et al. 2005

Z Gastroenterol

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Aim: This prospective study aimed to compare the accuracy of echo enhanced ultrasound with spiral computed tomography (CT) in assessing acute pancreatitis and to explore the correlation between ultrasound findings and clinical outcome. Methods: Thirty one patients (24 men and 7 women, median age 39 years, range 19-67 years) with acute pancreatitis were investigated by contrast enhanced CT and echo enhanced ultrasound within 72 hours after admission. Echo enhanced ultrasound (with intravenous injection of 2.4 ml SonoVue, pulse inversion technique, mechanical index 0.1 to 0.2, Siemens Elegra) was performed following conventional ultrasound. Balthazar's grading system was used to measure CT and ultrasound severity indices (CTSI and USSI). Correlations between CTSI and USSI and between USSI and clinical parameters were tested by Spearman's rank correlation coefficient. Results: A strong correlation was demonstrated between CTSI and USSI (r = 0.807, p,0.01). Ultrasound correlated with the following: the Ranson score (r = 0.401, p,0.05), C-reactive protein levels 48 hours after admission (r = 0.536, p,0.01), duration of hospitalisation (r = 0.422, p,0.05), and clinical outcome regarding morbidity, including local and systemic complications (r = 0.363, p,0.05). Based on CT findings as the gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detecting severe acute pancreatitis based on imaging criteria (Balthazar score D or E and/or presence of hypoperfusion compatible with necrosis and/or SI>3) were, respectively, 82% (95% CI 61 to 93), 89% (95% CI 57 to 98), 95% (95% CI 75 to 99), and 67% (95% CI 39 to 86). Conclusion: Echo enhanced ultrasound produces excellent results in the staging of acute pancreatitis severity. The procedure is cheaper and has fewer contraindications than CT. Further multicentre studies need to be performed before including the method in the diagnostic algorithm of patients with acute pancreatitis.

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Differentiation of Pancreatic Tumours by Conventional Ultrasound, Unenhanced and Echo-Enhanced Power Doppler Sonography

Abstract: Echo-enhanced power Doppler sonography has a high sensitivity and specificity in the differential diagnosis of pancreatic tumours. However, histology is the standard of reference.

Cited by 122 publications

References 17 publications

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

New-onset type 2 diabetes mellitus – A high-risk group suitable for the screening of pancreatic cancer?

Echo-enhanced ultrasound – A new valid initial imaging approach for severe acute pancreatitis

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