Quantitative elastography associated with endoscopic ultrasound for the diagnosis of chronic pancreatitis

Iglesias‐García, Julio; Domínguez‐Muñoz, J. Enrique; Castiñeira-Alvariño, Marga; Luaces-Regueira, Maria; Lariño‐Noia, José

doi:10.1055/s-0033-1344614

Cited by 112 publications

(95 citation statements)

References 22 publications

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“…Itokawa et al (27) introduced the concept of strain ratio (SR) as a semiquantitative method to objectively evaluate tissue hardness, which is simply the ratio of the distortions produced by a force on two adjacent areas. In 2013, Iglesias-García et al (23) obtained a diagnostic accuracy of 91.1% by EUSelastography using the SR for CP with a cut-off of 2.25, describing a direct correlation between the SR and the different stages of CP according to the Rosemont classification. EUS-elastography, despite obtaining a high diagnostic accuracy using indirect quantification methods, is a dependent operator technique and has a relative degree of invasiveness.…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic elastography associated with EUS is currently considered to be a complementary and useful tool in diagnosing CP, and could even classify patients according to severity (23,24). However, whether less invasive capacity techniques, such as percutaneous ARFI based elastography, could be equally relevant needs to be systematically determined.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis

et al. 2016

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Objective: To determine the accuracy of the acoustic radiation force impulse (ARFI) technique for the diagnosis of chronic pancreatitis. Materials and methods:We present an observational, single-center study that included patients with suspected chronic pancreatitis in the period between October 2012 and September 2015 who underwent endoscopic ultrasound (EUS) and were classified according to the standard and Rosemont criteria. The same group of patients was assessed by the ARFI technology using ACUSON S2000™ equipment with Virtual Touch™ Quantification software for the assessment of pancreatic stiffness by obtaining the shear wave velocity (SWV) in the head, body and tail of the pancreas. Data were analyzed using ANOVA and nonparametric correlation methods. Diagnostic accuracy was obtained by analyzing receiver operating characteristic (ROC) curve.Results: A total of thirty-three patients were studied (45.5% women); mean age was 58.3 ± 11.8 years. Seventeen with a diagnosis of chronic pancreatitis and sixteen classified as normal according to standard criteria. A significant difference was detected between the means of SWV in pancreatic body of patients without (SWV: 1.27 m/s) and with chronic pancreatitis (SWV 1.57 m/s), p = 0.037. The area under the ROC curve was 71.3% (95% CI 0.532-0.895) and the accuracy of ARFI for diagnosing chronic pancreatitis was 69.7% for a SWV of 1.4 m/s in the pancreatic body. The SWV means in head (r = 0.421, p < 0.05) and body (r = 0.455, p < 0.05) of the pancreas showed a significant correlation with the number of EUS criteria for chronic pancreatitis.Conclusion: Quantification of pancreatic stiffness with ARFI elastography technique has proven to be useful for the non-invasive diagnosis of chronic pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis

et al. 2016

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“…They reported when using 4 parameters of mean, standard deviation, skewness, kurtosis, there were significant correlation between 4 parameters and grade of fibrosis evaluated pathologically (r = 0.75, 0.54, 0.69, and 0.67, respectively). Iglesias Garcia et al [63] subjected 191 chronic pancreatitis, and compared strain ratio with Rosemont classification, a well-known diagnostic criteria for chronic pancreatitis evaluated by EUS. They reported that there was positive correlation between strain ratio and Rosemont classification (r = 0.813, P < 0.0001).…”

Section: Eus-elastography -Strain Elastographymentioning

confidence: 99%

Elastography for the pancreas: Current status and future perspective

Kawada¹,

Tanaka²

2016

WJG

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Elastography for the pancreas can be performed by either ultrasound or endoscopic ultrasound (EUS). There are two types of pancreatic elastographies based on different principles, which are strain elastography and shear wave elastography. The stiffness of tissue is estimated by measuring the grade of strain generated by external pressure in the former, whereas it is estimated by measuring propagation speed of shear wave, the transverse wave, generated by acoustic radiation impulse (ARFI) in the latter. Strain elastography is difficult to perform when the probe, the pancreas and the aorta are not located in line. Accordingly, a fine elastogram can be easily obtained in the pancreatic body but not in the pancreatic head and tail. In contrast, shear wave elastography can be easily performed in the entire pancreas because ARFI can be emitted to wherever desired. However, shear wave elastography cannot be performed by EUS to date. Recently, clinical guidelines for elastography specialized in the pancreas were published from Japanese Society of Medical Ultrasonics. The guidelines show us technical knacks of performing elastography for the pancreas. Core tip: Elastography for the pancreas had been considered to be difficult to perform with adequate accuracy and reproducibility because the pancreas is a small organ located deep in center of the human body. This review introduces the recent innovation of elastography for the pancreas, and makes recommendations on how to use various elastographic modalities for the pancreas. The review also shows us what we can know by performing elastography for the pancreas. Elastography may be a promising imaging modality for differential diagnosis between malignant and benign pancreatic tumors, for early diagnosis of chronic pancreatitis, and for identifying high-risk patients for pancreatic cancer. TOPIC HIGHLIGHTKawada N, Tanaka S. Elastography for the pancreas: Current status and future perspective.

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“…Investigations may include computed tomography (CT) or magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) [19].…”

Section: Introductionmentioning

confidence: 99%

Should we Investigate Gastroenterology Patients for Pancreatic Exocrine Insufficiency? A Dual Centre UK Study

Campbell

Sanders

Francis

et al. 2016

JGLD

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Background & Aims: Pancreatic exocrine insufficiency may be under recognised in gastroenterological practice. We aimed to identify the prevalence of pancreatic insufficiency in secondary care gastroenterology clinics and determine if co-morbidity or presenting symptoms could predict diagnosis. A secondary aim was to assess response to treatment. Methods: A dual centre retrospective analysis was conducted in secondary care gastroenterology clinics. Patients tested for pancreatic exocrine insufficiency with faecal elastase-1 (FEL-1) between 2009 and 2013 were identified in two centres. Demographics, indication and co-morbidities were recorded in addition to dose and response to pancreatic enzyme replacement therapy. Binary logistic regression was used to assess if symptoms or co-morbidities could predict pancreatic insufficiency. Results: 1821 patients were tested, 13.1% had low FEL-1 (<200μg/g). This prevalence was sub-analysed with 5.4% having FEL-1 100-200μg/g (mild insufficiency) and 7.6% having faecal elastase readings <100μg/g. Low FEL-1 was most significantly associated with weight loss or steatorrhoea. Co-morbidity analysis showed that low levels were significantly associated with excess alcohol intake, diabetes mellitus or human immunodeficiency virus; 80.0% treated with enzyme supplements reported symptomatic benefit with no difference in response between high and low dose supplementation (p=0.761). Conclusion: Targeting the use of FEL-1 in individuals with specific symptoms and associated conditions can lead to improved recognition of pancreatic exocrine insufficiency in a significant proportion of secondary care patients. Intervening with lifestyle advice such as smoking cessation and minimising alcohol intake could improve outcomes. In addition, up to 80% of patients with low faecal elastase respond to supplementation. Abbreviations: CFA: coefficient of fat absorption; CP: chronic pancreatitis; ELISA: enzyme-linked immune-absorbent assay; PEI: pancreatic exocrine insufficiency; FEL-1: faecal elastase-1; HIV: human immunodeficiency virus; IBD: inflammatory bowel disease; IBS: irritable bowel syndrome; PERT: pancreatic enzyme replacement therapy.

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Quantitative elastography associated with endoscopic ultrasound for the diagnosis of chronic pancreatitis

Abstract: EUS-elastography was an accurate tool for the diagnosis of chronic pancreatitis and provided relevant and objective information to support EUS findings.

Cited by 112 publications

References 22 publications

Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis

Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis

Elastography for the pancreas: Current status and future perspective

Should we Investigate Gastroenterology Patients for Pancreatic Exocrine Insufficiency? A Dual Centre UK Study

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