title: Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens).
abstract: BACKGROUND
  An accurate diagnosis of pancreatic fibrosis is clinically important and may have potential for staging chronic pancreatitis. The aim of this study was to diagnose the grade of pancreatic fibrosis through a quantitative analysis of endoscopic ultrasound elastography (EUS-EG).
  
  
  METHODS
  From September 2004 to October 2010, 58 consecutive patients examined by EUS-EG for both pancreatic tumors and their upstream pancreas before pancreatectomy were enrolled. Preoperative EUS-EG images in the upstream pancreas were statistically quantified, and the results were retrospectively compared with postoperative histological fibrosis in the same area. For the quantification of EUS-EG images, 4 parameters (mean, standard deviation, skewness, and kurtosis) were calculated using novel software. Histological fibrosis was graded into 4 categories (normal, mild fibrosis, marked fibrosis, and severe fibrosis) according to a previously reported scoring system.
  
  
  RESULTS
  The fibrosis grade in the upstream pancreas was normal in 24 patients, mild fibrosis in 19, marked fibrosis in 6, and severe fibrosis in 9. Fibrosis grade was significantly correlated with all 4 quantification parameters (mean r = -0.75, standard deviation r = -0.54, skewness r = 0.69, kurtosis r = 0.67). According to the receiver operating characteristic analysis, the mean was the most useful parameter for diagnosing pancreatic fibrosis. Using the mean, the area under the ROC curves for the diagnosis of mild or higher-grade fibrosis, marked or higher-grade fibrosis and severe fibrosis were 0.90, 0.90, and 0.90, respectively.
  
  
  CONCLUSIONS
  An accurate diagnosis of pancreatic fibrosis may be possible by analyzing EUS-EG images.
authors.affiliation: Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Itoh
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: 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: Daijuro
authors.initials: D
authors.lastname: Hayashi
authors.forename: Takamichi
authors.initials: T
authors.lastname: Kuwahara
authors.forename: Tomomasa
authors.initials: T
authors.lastname: Morishima
authors.forename: Kohei
authors.initials: K
authors.lastname: Funasaka
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: Yoshiaki
authors.initials: Y
authors.lastname: Katano
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Ishigami
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
mesh_terms: D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods; D019160:Endosonography / Q000379:methods; D005260:Female; D005355:Fibrosis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000150:complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
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