The application value of contrast-enhanced ultrasound in the differential diagnosis of pancreatic solid-cystic lesions

Xu, Ming; Xie, Xiaoyan; Liu, Guangjian; Xu, Hui‐Xiong; Xu, Zuo-Feng; Huang, Guangliang; Chen, Pei-Fen; Luo, Jia; Lü, Ming-De

doi:10.1016/j.ejrad.2011.03.048

Cited by 25 publications

(19 citation statements)

References 12 publications

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“…CEUS is generally acknowledged to be able to detect the inner structure of the CPLs, such as septa, nodules, and clearer wall characteristics 14,15,18,27. Many studies have demonstrated the superior performance of CEUS over conventional US for the diagnosis of CPLs,21 the usefulness of qualitative and quantitative CEUS analysis,19 the substantial agreement with CECT,20,23 the value in char-acterizing different pancreatic pathologies and the agreement with MRI images 22,28. Nevertheless, no study has discussed the detailed features of these two diseases and whether the features or their combinations were of any value in the discrimination of SCAs and MCAs using CEUS.…”

Section: Discussionmentioning

confidence: 99%

“…The following criteria were not statistically significantly different between SCAs and MCAs: size, echogenicity, enhancement pattern of the wall, nodules, and thickness of the septum (the cut-off value of the thickness was 2 mm). The different echogenicity characteristics are influenced by septa, a hemorrhage, mucin, and sometimes, when chambers are extremely small, the tumor may appear solid 21. The enhancement pattern of the wall assessed by objective judgment cannot be a useful criterion because a large number of the walls were hyper enhanced and sometimes the enhancement pattern was difficult to discern in thin walls.…”

Section: Discussionmentioning

confidence: 99%

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Discrimination of serous cystadenoma from mucinous cystadenoma in the pancreas with contrast-enhanced ultrasonography: a prospective study in 61 patients

Sun¹,

Zhou²,

Liu³

et al. 2017

OTT

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ObjectivesThe preoperative diagnosis between serous cystadenomas (SCAs) and mucinous cystadenomas (MCAs) in pancreas is significant due to their completely different biological behaviors. The purpose of our study was to examine and compare detailed contrast-enhanced ultrasonography (CEUS) images of SCAs and MCAs and to determine whether there are significant findings that can contribute to the discrimination between these two diseases.MethodsFrom April 2015 to June 2016, 61 patients (35 patients with SCAs and 26 patients with MCAs) were enrolled in this study. Forty-three cases were confirmed by surgical pathology and 18 by comprehensive clinical diagnoses. All of the CEUS characteristics of these lesions were recorded: size, location, echogenicity, shape, wall characteristics, septa characteristics, and the presence of a honeycomb pattern or nodules. CEUS examinations were performed by two ultrasound physicians.ResultsLocation (P=0.003), shape (P=0.000), thickness of the wall (P=0.005), the number of septa (P=0.001), and the honeycomb pattern (P=0.001) were statistically significantly different. A head–neck location, a lobulated shape, an inner regular honeycomb pattern, and a thin wall (<3 mm thick) were significant in diagnosing patients with SCAs. When two of these four findings were combined, we could achieve a sensitivity of 71.4% and a specificity of 80.8% to diagnose SCA; when three of these four findings were combined, the specificity was 100%. A body–tail location, a round/oval shape, 0–2 septa, and a thick wall (≥3 mm thick) were most often detected in patients with MCAs. When two of these four findings were combined, we could achieve a sensitivity of 88.5% and a specificity of 65.7% to diagnose MCA; when three of these four findings were combined, the area under the curve (Az) was highest at 0.832, with a sensitivity of 80.8% and a specificity of 85.7%.ConclusionsThe characteristics of tumor location, shape, thickness of the wall, the number of septa, and the honeycomb pattern by CEUS play an important role in the diagnosis of SCAs and MCAs. A combination of these findings can provide better diagnostic performance in the discrimination of SCAs from MCAs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Discrimination of serous cystadenoma from mucinous cystadenoma in the pancreas with contrast-enhanced ultrasonography: a prospective study in 61 patients

Sun¹,

Zhou²,

Liu³

et al. 2017

OTT

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“…The present study also compared and analyzed the diagnostic capacity of all the time and intensity parameters using ROC curve analysis (26). ROC uses the false-positive rate (1-specificity) as the x-axis, and sensitivity as the y-axis, to generate the curve.…”

Section: Discussionmentioning

confidence: 99%

Quantitative contrast-enhanced ultrasonography for the differential diagnosis of endometrial hyperplasia and endometrial neoplasms

Liu

Cheng

et al. 2016

Oncology Letters

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The present study aimed to investigate the feasibility of applying contrast-enhanced ultrasonography (CEUS) imaging technology for distinguishing between benign and malignant endometrial lesions, and to screen markers that could be correlated with the pathological results. In this study, endometrial diseases were diagnosed by biopsy under hysteroscopy and CEUS examinations. The intensity and time parameters of the time-intensity curve (TIC) were analyzed. The mean arrival time (AT), time-to-peak (TTP), rise time (RT), washout half-time and clearance half-time of malignant lesions were shorter than those of benign lesions (P<0.05), whereas the average peak intensity (PI) and enhancement intensity (EI) of malignant lesions were higher than those of benign lesions (P<0.05). The receiver operating characteristic curve showed the following cut-off values: PI, 29.2 dB; EI, 21.35 dB; AT, 12.75 sec; TTP, 26.75 sec; RT, 13.2 sec; clearance half-time, 89.3 sec; and washout half-time, 75.45 sec. The lesions with PI, an EI higher than that of the cut-off and lesions with an AT, TTP, RT, half clearing time and washout half-time shorter than the cut-off were considered malignant. The TTP, RT and half clearing time were negatively correlated with microvessel density (MVD), i.e., MVD was higher when the TTP, RT and half clearing time were shorter. Overall, changes in the enhancement and clearing of lesions could be quantitatively analyzed by CEUS TIC and further discriminate benign from malignant lesions. In the present study, CEUS appeared to indirectly reflect blood vessel changes inside the lesions and provided a pre-operative non-invasive fast imaging method for the diagnosis of endometrial disease.

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“…EUS alone cannot reliably differentiate between benign and malignant pancreatic cystic lesions, but EUS offers guidance for fine needle aspiration (FNA) of cystic lesions which has been demonstrated to be as accurate as CT-guided FNA. Volmar et al [46] reported that for lesions <3 cm, the EUS-guided FNA had higher accuracy than US or CT. With CT or EUS guidance, samples of the cystic fluid and cyst walls can be taken by fine needle aspiration and brushing for cytology and measurement of tumour markers, viscosity, and amylase (that will be described in the further part of this paper) [17,28,[47][48][49][50][51][52]. Similar to transabdominal US, EUS also allows a therapeutic approach such as EUS-guided pancreatic pseudocyst drainage (that will be discussed in a chapter regarding management) [53][54][55][56][57][58][59][60][61].…”

Section: Endoscopic Ultrasnonography (Eus)mentioning

confidence: 99%

“…Beyer et al [45] compared the conventional US with CEUS in differentiation of pseudocysts versus neoplasia and concluded that conventional US had a sensitivity of 94% and a low specificity of 44% whereas CEUS had a higher specificity of 77% with the same sensitivity of conventional USG. Xu et al [46] compared the accuracy of the conventional US with CEUS in diagnostics of 54 solid-cystic pancreatic lesions and concluded that CEUS characterized a significant higher diagnostic accuracy compared to conventional US.…”

Section: Contrast Enhanced Ultrasonography (Ceus)mentioning

confidence: 99%

Pancreatic cysts: etiology, diagnosis and management

Jabłońska

2014

Open Medicine

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AbstractPancreatic cysts involve a wide spectrum of pathologies from post-inflammatory cysts to malignant neoplasms. Pancreatic pseudocysts, serous cystadenomas, mucinous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary tumors occur most frequently. Differential diagnosis involves the following imaging investigations: transabdominal ultrasonography (TUS), contrast enhanced ultrasonography (CEUS) and endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance (MR) and magnetic resonance cholangiopancretography (MRCP), endoscopic retrograde cholangiopancretography (ERCP). The cyst fluid cytology is performed in difficult differential diagnosis between pseudocysts and benign and potentially malignant or malignant tumors. Most frequently, viscosity, amylase, CEA and CA 19-9 levels are determined. Imaging findings should be correlated with cytology. The management depends on the cyst type and size. Small asymptomatic pseudocysts, serous cystadenomas and branchduct IPMNs should be carefully observed, whereas symptomatic large or uncertain serous cystadenomas and cystadenocarcinomas, mucinous cystadenomas and cystadenocarcinomas, main-duct IPMNs and large branch-duct IPMNs with malignant features, serous and mucinous cystadenocarcinomas, and solid pseudopapillary tumors require surgery. Pseudocysts are usually drained. Percutaneous / EUS-guided or surgical cyst drainage can be performed. Complicated and uncertain pseudocysts and cystic tumors need surgical resection. The type of surgery depends on cyst location and size and includes proximal, central, distal, total pancreatectomies and enucleation.

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The application value of contrast-enhanced ultrasound in the differential diagnosis of pancreatic solid-cystic lesions

Cited by 25 publications

References 12 publications

Discrimination of serous cystadenoma from mucinous cystadenoma in the pancreas with contrast-enhanced ultrasonography: a prospective study in 61 patients

Discrimination of serous cystadenoma from mucinous cystadenoma in the pancreas with contrast-enhanced ultrasonography: a prospective study in 61 patients

Quantitative contrast-enhanced ultrasonography for the differential diagnosis of endometrial hyperplasia and endometrial neoplasms

Pancreatic cysts: etiology, diagnosis and management

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