title: Contrast-enhanced endoscopic ultrasonography in digestive diseases.
abstract: Contrast-enhanced endoscopic ultrasonography (CE-EUS) was introduced in the early 1990s. The concept of the injection of carbon dioxide microbubbles into the hepatic artery as a contrast material (enhanced ultrasonography) led to "endoscopic ultrasonographic angiography". After the arrival of the first-generation contrast agent, high-frequency (12 MHz) EUS brought about the enhancement of EUS images in the diagnosis of pancreatico-biliary diseases, upper gastrointestinal (GI) cancer, and submucosal tumors. The electronic scanning endosonoscope with both radial and linear probes enabled the use of high-end ultrasound machines and depicted the enhancement of both color/power Doppler flow-based imaging and harmonic-based imaging using second-generation contrast agents. Many reports have described the usefulness of the differential diagnosis of pancreatic diseases and other abdominal lesions. Quantitative evaluation of CE-EUS images was an objective method of diagnosis using the time-intensity curve (TIC), but it was limited to the region of interest. Recently developed Inflow Time Mapping™ can be generated from stored clips and used to display the pattern of signal enhancement with time after injection, offering temporal difference of contrast agents and improved tumor characterization. On the other hand, three-dimensional CE-EUS images added new information to the literature, but lacked positional information. Three-dimensional CE-EUS with accurate positional information is awaited. To date, most reports have been related to pancreatic lesions or lymph nodes. Hemodynamic analysis might be of use for diseases in other organs: upper GI cancer diagnosis, submucosal tumors, and biliary disorders, and it might also provide functional information. Studies of CE-EUS in diseases in many other organs will increase in the near future.
authors.affiliation: Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-Cho, Showa-ku, Nagoya City, Japan. hirooka@med.nagoya-u.ac.jp
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
authors.forename: Akihiro
authors.initials: A
authors.lastname: Itoh
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawashima
authors.forename: Eizaburo
authors.initials: E
authors.lastname: Ohno
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: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Hajime
authors.initials: H
authors.lastname: Sumi
authors.forename: Daijiro
authors.initials: D
authors.lastname: Hayashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
authors.forename: Ryoji
authors.initials: R
authors.lastname: Miyahara
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakamura
authors.forename: Kohei
authors.initials: K
authors.lastname: Funasaka
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
mesh_terms: D003287:Contrast Media; D003937:Diagnosis, Differential; D004066:Digestive System Diseases / Q000000981:diagnostic imaging*; D019160:Endosonography / Q000379:methods*; D006801:Humans; D018608:Ultrasonography, Doppler
chemical_list: D003287:Contrast Media