title: Contrast-enhanced harmonic endoscopic ultrasonography for pancreatobiliary diseases.
abstract: The combination of second-generation ultrasound contrast agents and an endoscopic ultrasonography (EUS) system with a broad-band transducer has allowed contrast-enhanced harmonic imaging in the field of EUS. In contrast-enhanced harmonic EUS (CH-EUS), diffuse homogeneous enhancement is obtained in normal parenchyma of the pancreas. The bile duct and pancreatic duct are depicted as non-enhanced ductal structures with strong contrast in comparison to the surrounding parenchyma. CH-EUS identifies pancreatic adenocarcinomas as solid lesions exhibiting hypo-enhancement with a sensitivity and specificity of 88-96% and 88-94%, respectively. In particular, 80-100% of false-negative cases in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are correctly classified by CH-EUS, suggesting CH-EUS complements EUS-FNA. Moreover, CH-EUS improves depiction of some subtle lesions in conventional EUS, thus facilitating EUS-FNA. For quantitative perfusion analysis, a time-intensity curve (TIC) for the region of interest can be generated during CH-EUS. The maximum intensity gain and the echo intensity reduction rate from the peak at 1 min obtained by TIC can be used for differentiation of pancreatic adenocarcinoma from other tumors. CH-EUS is also useful for differentiation of invasive intraductal papillary mucinous neoplasms (IPMN) from non-invasive IPMN, identification of malignant lesions in the gallbladder, and T- and N-staging of pancreatobiliary tumors.
authors: Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka, Japan.
authors: Masayuki
authors: M
authors: Kitano
authors: Ken
authors: K
authors: Kamata
authors: Hajime
authors: H
authors: Imai
authors: Takeshi
authors: T
authors: Miyata
authors: Satoru
authors: S
authors: Yasukawa
authors: Akio
authors: A
authors: Yanagisawa
authors: Masatoshi
authors: M
authors: Kudo
mesh_terms: D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000628:therapy; D003287:Contrast Media; D054459:Elasticity Imaging Techniques; D019160:Endosonography; D006801:Humans; D007089:Image Enhancement; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000628:therapy; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS); endoscopic ultrasonography (EUS); pancreatic carcinoma; pancreatobiliary disease