Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer.
OBJECTIVE
To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels.


METHODS
In 86 patients with suspected chronic pancreatitis (age: 62+/-12 years; sex: f/m 38/48), pancreatic lesions were examined by conventional endoscopic B-mode, power Doppler ultrasound and contrast-enhanced power mode (Hitachi EUB 525, SonoVue, 2.4 mL, Bracco) using the following criteria for malignant lesions: no detectable vascularisation using conventional power Doppler scanning, irregular appearance of arterial vessels over a short distance using SonoVue contrast-enhanced technique and no detectable venous vessels inside the lesion. A malignant lesion was assumed if all criteria were detectable [gold standard endoscopic ultrasound (EUS)-guided fine needle aspiration cytology, operation]. The criteria of chronic pancreatitis without neoplasia were defined as no detectable vascularisation before injection of SonoVue, regular appearance of vessels over a distance of at least 20 mm after injection of SonoVue and detection of arterial and venous vessels.


RESULTS
The sensitivity and specificity of conventional EUS were 73.2% and 83.3% respectively for pancreatic cancer. The sensitivity of contrast-enhanced EUS increased to 91.1% in 51 of 56 patients with malignant pancreatic lesion and the specificity increased to 93.3% in 28 of 30 patients with chronic inflammatory pancreatic disease.


CONCLUSIONS
Contrast-enhanced endoscopic ultrasound improves the differentiation between chronic pancreatitis and pancreatic carcinoma.
Department of Internal Medicine II, Friedrich Schiller University Jena, Erlanger Allee 101, 07740 Jena, Germany. Michael.hocke@med.uni-jena.de
Michael
M
Hocke
Ewald
E
Schulze
Peter
P
Gottschalk
Theodor
T
Topalidis
Christoph F
CF
Dietrich
D000328:Adult; D000368:Aged; D003287:Contrast Media; D019160:Endosonography; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D010195:Pancreatitis / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler
D003287:Contrast Media