title: Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos).
abstract: BACKGROUND
  Contrast-enhanced power Doppler (CEPD) and real-time sonoelastography (RTSE) performed during EUS were previously described to be useful for the differential diagnosis between chronic pseudotumoral pancreatitis and pancreatic cancer.
  
  
  OBJECTIVE
  To prospectively assess the accuracy of the combination of CEPD and RTSE to differentiate pancreatic focal masses.
  
  
  METHODS
  Cross-sectional feasibility study.
  
  
  METHODS
  A tertiary-care academic referral center.
  
  
  METHODS
  The study group included 54 patients with chronic pancreatitis (n = 21) and pancreatic adenocarcinoma (n = 33).
  
  
  METHODS
  Both imaging methods (CEPD and RTSE) were performed sequentially during the same EUS examination. Power Doppler mode examination was performed after intravenous injection of a second-generation contrast agent (2.4 mL of SonoVue), and the data were digitally recorded, comprising both the early arterial phase and venous/late phase. Three 10-second sonoelastographic videos were also digitally recorded that included the focal mass and the surrounding pancreatic parenchyma. Postprocessing analyses based on specially designed software were used to analyze the CEPD and RTSE videos. A power Doppler vascularity index was used to characterize CEPD videos, the values being averaged during a 10-second video in the venous phase. Hue histogram analysis was used to characterize RTSE videos, with the mean hue histogram values being also averaged during a 10-second video.
  
  
  METHODS
  To differentiate chronic pancreatitis and pancreatic cancer.
  
  
  RESULTS
  The sensitivity, specificity, and accuracy of combined information provided by CEPD and RTSE to differentiate hypovascular hard masses suggestive of pancreatic carcinoma were 75.8%, 95.2%, and 83.3%, respectively, with a positive predictive value and negative predictive value of 96.2% and 71.4%, respectively.
  
  
  CONCLUSIONS
  A single-center, average size of study population.
  
  
  CONCLUSIONS
  A combination of CEPD and RTSE performed during EUS seems to be a promising method that allows characterization and differentiation of focal pancreatic masses.
authors.affiliation: Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania. adry@umcv.ro
authors.forename: Adrian
authors.initials: A
authors.lastname: Săftoiu
authors.forename: Sevasti A
authors.initials: SA
authors.lastname: Iordache
authors.forename: Dan Ionu
authors.initials: DI
authors.lastname: Gheonea
authors.forename: Carmen
authors.initials: C
authors.lastname: Popescu
authors.forename: Anca
authors.initials: A
authors.lastname: Maloş
authors.forename: Florin
authors.initials: F
authors.lastname: Gorunescu
authors.forename: Tudorel
authors.initials: T
authors.lastname: Ciurea
authors.forename: Alexandru
authors.initials: A
authors.lastname: Iordache
authors.forename: Gabriel Lucian
authors.initials: GL
authors.lastname: Popescu
authors.forename: C T Lin
authors.initials: CT
authors.lastname: Manea
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging*; D010743:Phospholipids; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018608:Ultrasonography, Doppler / Q000379:methods*
chemical_list: D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride