title: Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases.
abstract: OBJECTIVE
  This study aimed to investigate the usefulness of contrast-enhanced endoscopic ultrasonography (EUS) with time-intensity curve (TIC) in differentiating pancreatic diseases.
  
  
  METHODS
  Patients who underwent contrast-enhanced EUS between January 2007 and June 2009 were analyzed retrospectively, including 48 with pancreatic ductal cancer (PC), 14 with autoimmune pancreatitis (AIP), 13 with mass-forming pancreatitis (MFP), and 16 with pancreatic endocrine tumor (PET). After intravenous injection of contrast agent, contrast imaging pattern, TIC-based quantitative evaluation, and diagnostic ability of EUS in combination with TIC to diagnose benignancy or malignancy were assessed.
  
  
  RESULTS
  Hypovascular and heterogeneous pattern (42/48) in PC, isovascular and homogenous (21/27) in AIP and MFP, and hypervascular and rapid stained (16/16) in PET were observed. The echo intensity reduction rate from the peak at 1 minute was the greatest in PC followed by MFP, AIP, and PET (P < 0.05). The diagnostic accuracies based on contrast imaging pattern (84.0%) and TIC (88.0%) were higher than those based on B-mode imaging (82.6%) and dynamic computed tomography (81.3%). In EUS in combination with TIC, sensitivity, specificity, and accuracy rose up to 95.8%, 92.6%, and 94.7%, respectively.
  
  
  CONCLUSIONS
  Contrast-enhanced EUS with the dynamic quantitative analysis preparing TIC increased the diagnostic accuracy for pancreatic diseases.
authors.affiliation: Department of Gastroenterology, Nagoya University Graduate School of Medicine, and †Department of Endoscopy, Nagoya University Hospital, Nagoya City, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsubara
authors.forename: Akihiro
authors.initials: A
authors.lastname: Itoh
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawashima
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Kasugai
authors.forename: Eizaburo
authors.initials: E
authors.lastname: Ohno
authors.forename: Takuya
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Yuya
authors.initials: Y
authors.lastname: Itoh
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hiramatsu
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakamura
authors.forename: Ryoji
authors.initials: R
authors.lastname: Miyahara
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Ishigami
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Katano
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007501:Iron; D007564:Japan; D008297:Male; D008875:Middle Aged; D010087:Oxides; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D010195:Pancreatitis / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron