Echo-enhanced color- and power-Doppler EUS for the discrimination between focal pancreatitis and pancreatic carcinoma.
BACKGROUND
EUS is a precise method for detection and staging of pancreatic tumors. However, differentiation between inflammatory pseudotumor and pancreatic carcinoma remains difficult. The aim of this study was to evaluate contrast-enhanced EUS as a method of differentiating inflammation and carcinoma based on perfusion characteristics.


METHODS
Patients with solid pancreatic masses underwent EUS with a linear echoendoscope. Perfusion in the pancreatic tissue and the mass was assessed with native and contrast-enhanced EUS with power- and color-Doppler imaging. Examinations were evaluated by a blinded reader. A markedly hyperperfused lesion was considered an inflammatory pseudotumor whereas lesions that were hypoperfused compared with surrounding tissue were considered to be carcinoma.


RESULTS
Fifteen of 23 patients had hypoperfusion within the mass and 8 patients had hyperperfused lesions. Of the 15 patients with hypoperfused masses, all had pancreatic adenocarcinoma; 1 of 8 patients with a hyperperfused lesion also had adenocarcinoma. The remaining 7 patients had focal inflammation. Sensitivity for differentiation of pancreatic carcinoma versus inflammatory changes was 94%, specificity 100%.


CONCLUSIONS
Echo-enhanced power-Doppler EUS reliably differentiates pancreatic neoplasm and focal pancreatitis. The diagnostic accuracy of this technique is comparable to CT, magnetic resonance imaging, positron emission tomography, and ERCP.
Becker
D
D
Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Strobel
D
D
Bernatik
T
T
Hahn
E G
EG
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000418:Albumins; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003287:Contrast Media; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D005466:Fluorocarbons; D006104:Granuloma, Plasma Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000473:pathology; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons