title: Contrast-enhanced ultrasonography depicts small tumor vessels for the evaluation of pancreatic tumors.
abstract: OBJECTIVE
  The aim of this study is to evaluate the efficacy of contrast-enhanced ultrasonography for the diagnosis of pancreatic tumors.
  
  
  METHODS
  Contrast-enhanced ultrasonography with Levovist was performed on 62 consecutive patients (53 with pancreatic cancer, 4 with islet cell tumor, 3 with inflammatory pancreatic tumor, and 2 with metastatic tumor). The vascular and perfusion image phases of the tumors were evaluated and compared with the findings of contrast-enhanced computed tomography.
  
  
  RESULTS
  Contrast-enhanced ultrasonography showed tumor vessels around and/or in the tumor at the vascular image phase in 79% of pancreatic cancer patients (42/53). At the perfusion image phase, 96% of pancreatic cancers (51/53) were classified as hypo-enhancement type. However, tiny spotty or irregular heterogeneous enhanced lesions were found in 84% of hypo-enhanced pancreatic cancer patients (43/51). The presence of small vessels at the vascular image phase was closely correlated with the presence of these intratumor regional enhanced lesions at the perfusion image phase (kappa coefficient=0.42). The sensitivity of contrast-enhanced ultrasonography (100%) for pancreatic cancer was superior to that of contrast-enhanced computed tomography (91%), but no significant difference was observed between the two (McNemar test: p=0.063).
  
  
  CONCLUSIONS
  Contrast-enhanced ultrasonography with Levovist successfully visualizes fine vessels and enhancement in pancreatic tumors, and is useful for evaluating pancreatic tumors.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama 700-8558, Japan. h-kawamo@md.okayama-u.ac.jp
authors.forename: Yuko
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Akinobu
authors.initials: A
authors.lastname: Takaki
authors.forename: Etsuji
authors.initials: E
authors.lastname: Ishida
authors.forename: Tsuneyoshi
authors.initials: T
authors.lastname: Ogawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuwaki
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Kohsaku
authors.initials: K
authors.lastname: Sakaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shiratori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging*; D011134:Polysaccharides; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508