title: Contrast-enhanced ultrasound in the differential diagnosis of exocrine versus neuroendocrine pancreatic tumors.
abstract: OBJECTIVE
  Contrast-enhanced ultrasound (CEUS) has been developed to better characterize the microvasculature of solid masses in several organs, including the pancreas. In this study, we assessed CEUS accuracy in differentiating exocrine from endocrine pancreatic tumors.
  
  
  METHODS
  A total of 127 patients with single, undetermined pancreatic masses were prospectively examined with transabdominal ultrasound and CEUS, before surgical resection or percutaneous biopsy.
  
  
  RESULTS
  Exocrine and endocrine pancreatic tumors showed different intralesional vascularization patterns: 98.9% (90/91) of exocrine tumors were hypoenhancing, whereas 95.8 % (23/24) of endocrine tumors had a hypervascular supply. A hypoenhancing pattern, indicative of ductal adenocarcinoma, had a significant (P < 0.001) diagnostic accuracy of 91.3% with a sensitivity of 96.8%, a specificity of 85.3%, a positive predictive value and a negative predictive value of 94.7% and 90.6%, respectively. The hyperenhancing pattern, indicative of endocrine tumors, had a significant (P = 0.031) diagnostic accuracy of 73.8% with a sensitivity of 83.3%, a specificity of 60.0%, a positive predictive value and negative predictive value of 83.3% and 60.0%, respectively.
  
  
  CONCLUSIONS
  Contrast-enhanced ultrasound has a valuable diagnostic accuracy in differentiating exocrine from endocrine pancreatic tumors, which is a fundamental step to address appropriate histological evaluation, therapeutic approach, and follow-up.
authors.affiliation: Department of Medical and Surgical Sciences/Digestive Diseases and Internal Medicine, St Orsola-Malpighi Hospital Bologna, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Serra
authors.forename: Cristina
authors.initials: C
authors.lastname: Felicani
authors.forename: Elena
authors.initials: E
authors.lastname: Mazzotta
authors.forename: Lydia
authors.initials: L
authors.lastname: Piscitelli
authors.forename: Maria Luigia
authors.initials: ML
authors.lastname: Cipollini
authors.forename: Paola
authors.initials: P
authors.lastname: Tomassetti
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Morselli-Labate
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Stanghellini
authors.forename: Roberto
authors.initials: R
authors.lastname: Corinaldesi
authors.forename: Roberto
authors.initials: R
authors.lastname: De Giorgio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000000981:diagnostic imaging*; D046790:Pancreas, Exocrine / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media