<p>Comparative Diagnostic Evaluation with Contrast-Enhanced Ultrasound, Computed Tomography and Magnetic Resonance Imaging in Patients with Pancreatic Cystic Neoplasms</p>

Abstract

The purpose of our study was to evaluate the role of contrast-enhanced ultrasound (CEUS) with magnetic resonance imaging (MRI) and computed tomography (CT) in the pathological diagnosis of pancreatic cystic neoplasms (PCNs). Methods: A total of 90 patients (66 women, 24 men) aged 18-71 years were studied prospectively. CEUS was performed in all patients, whereas MRI was performed in 85 patients and CT in 69 patients. We analyzed the sensitivity and accuracy of these three imaging modalities to diagnose the PCNs. Neoplasm size, location, shape, intralesional mural nodules, septa and duct dilatation were also assessed by different radiologists. Results: There were no significant differences in sensitivity for discriminating PCNs from pancreatic cystic lesions between CEUS and MRI (p=0.614) or between CEUS and CT (p=0.479). The diagnostic accuracy of CEUS for classifying PCNs was 64.4% (58/90), which was higher than that of CT (53.6%, 37/69, P=0.017), and lower than that of MRI (70.6%, 60/ 85, p=0.791). Regarding tumor size for lesions larger than 3 cm, CEUS was superior to CT in differentiating the specific type of PCN (p=0.041), and CEUS had the same value as MRI (p=0.774). Furthermore, CEUS is valuable for precisely characterizing internal structures, for instance, septa (p=0.003, compared with CT; p=0.443, compared with MRI) and nodules (p= 0.018, compared with CT; p=0.033, compared with MRI). The number of septa (p=0.033) and cyst morphology (p=0.016) were meaningful indicators in differentiating serous and mucinous adenoma. There was no significant difference in evaluating size and detecting duct dilatation among the three imaging methods. Conclusion: CEUS compares favorably with MRI in displaying the inner structure of PCNs and offers advantages over CT. CEUS can contribute in an important way to the diagnosis of pancreatic cystic neoplasms.

Automated Detection of Pancreatic Cystic Lesions on CT Using Deep Learning

“…For patients refusing an MRI, pancreatic CT is the recommended alternative modality according to the societies ICG, ACG and ESG [ 32 ], and offers a comparable accuracy to MRCP in terms of PCL characterization [ 42 ]. However, we recognize the high diagnostic value of other modalities such as multi-parametric MRI, MRCP, and endoscopic ultrasound (EUS) [ 4 , 32 , 43 , 44 ]. Consequently, even though our model provides help for the detection of PCLs on CT, models for other modalities would be useful for their accurate characterization.…”

Diagnostic Approach to Incidentally Detected Pancreatic Cystic Lesions

“…When doubts about the presence of mural nodules and worrisome features on cross-sectional imaging remain, contrast-enhanced EUS (CE-EUS) should be performed because of its ability to distinguish hyperenhancing solid components within PCLs, from non-enhancing mucus plugs [45,46]. Indeed, in a prospective study on 90 PCL patients, CE-EUS was more valuable for precise identification of mural nodules compared to CT (p = 0.018) and MRI (p = 0.033) [47]. Similar results have been found for detection of septal thickness [48].…”

The Role of Endoscopic Ultrasonography in the Diagnosis of Cystic Formulations of the Pantacratic Gland

“…КУПЗ відрізняються за клінічною картиною, морфологією та ризиком злоякісності [1,3]. Незалежно від того, чи використовується мультиспіральна комп'ютерна томографія (МСКТ), магнітно-резонансна томографія (МРТ) або навіть ЕУС, часто важко провести диференціальну діагностику осередкових новоутворень на тлі розвитку запальних або фіброзних змін паренхіми підшлункової залози (ПЗ) при гострому чи хронічному панкреатиті [4]. Типової клінічної картини при КУПЗ не існує, і якщо завдяки широкому поширенню ультразвукового дослідження виявлення кіст перестало бути серйозною проблемою, але їх диференціальна діагностика з неоплазіями досі становить зна-чні труднощі [5].…”

“…Однак, ЕУС не може вважатися «золотим стандартом» у діагностиці КУПЗ. Так, за даними різних досліджень, точність ендосонографії (без пункції) становить 40,0-96,0% [2,4]. Це пояснюється умовами проведення маніпуляції та завданнями, які були поставлені перед дослідниками (діагностика кістозних пухлин, їх диференціальна діагностика з виділенням зло-якісних форм).…”