title: Beyond conventional endoscopic ultrasound: elastography, contrast enhancement and hybrid techniques.
abstract: OBJECTIVE
  Endoscopic ultrasound (EUS) recently became a technique with a major clinical impact in digestive diseases. EUS determines a change in the diagnosis and management of more than half of examined patients. This review summarizes recent advances in the complementary EUS examination modalities such as elastography and microbubble contrast enhancement.
  
  
  RESULTS
  EUS elastography is a well documented method that allows characterization and differentiation of pancreatic cancer and chronic pancreatitis. Quantitative elastography methods, especially based on computer analyses, retrieve numeric values and possibly eliminate the human bias. The use of contrast-enhanced EUS also allows a better visualization and differentiation of focal pancreatic lesions. A hypoenhanced mass as compared with the surrounding pancreatic parenchyma is highly suggestive for pancreatic adenocarcinoma, whereas a hyperenhanced lesion indicates an inflammatory mass. Furthermore, hybrid EUS imaging techniques (in combination with computed tomography or magnetic resonance) might be useful for an increased diagnostic confidence.
  
  
  CONCLUSIONS
  Despite its advantages in assessing the organs situated near the gastrointestinal tract, EUS is still an operator-dependent technique. The new EUS examination modalities incorporated in modern ultrasound systems allow a highly accurate diagnosis.
authors.affiliation: Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania.
authors.forename: Dan-Ionuţ
authors.initials: DI
authors.lastname: Gheonea
authors.forename: Adrian
authors.initials: A
authors.lastname: Săftoiu
mesh_terms: D003287:Contrast Media; D054459:Elasticity Imaging Techniques; D019160:Endosonography; D006801:Humans; D008279:Magnetic Resonance Imaging; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media