title: Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses (with videos).
abstract: BACKGROUND
  The role of EUS with contrast agents can be expanded through the use of time-intensity curve (TIC) analysis and computer-aided interpretation.
  
  
  OBJECTIVE
  To validate the use of parameters derived from TIC analysis in an artificial neural network (ANN) classification model designed to diagnose pancreatic carcinoma (PC) and chronic pancreatitis (CP).
  
  
  METHODS
  Prospective, multicenter, observational trial-endoscopy units from Romania, Denmark, Germany, and Spain.
  
  
  METHODS
  A total of 167 consecutive patients with PC or CP.
  
  
  METHODS
  Contrast-enhanced harmonic EUS (CEH-EUS) and EUS-guided FNA (EUS-FNA), TIC analysis, and ANN processing.
  
  
  METHODS
  Sensitivity, specificity, positive and negative predictive values (PPV, NPV) for EUS-FNA, CEH-EUS, and the ANN.
  
  
  RESULTS
  After excluding all of the recordings that did not meet the technical and procedural criteria, 112 cases of PC and 55 cases of CP were included. EUS-FNA was performed in 129 patients, and the diagnosis was confirmed by surgery (n = 15) or follow-up (n = 23) in the remaining cases. Its sensitivity and specificity were 84.82% and 100%, respectively, whereas the PPV and NPV were 100% and 76.63%, respectively. The sensitivity of real-time quantitative assessment of CEH-EUS was 87.5%, specificity 92.72%, PPV 96.07%, and NPV 78.46%. Peak enhancement, wash-in area under the curve, wash-in rate, and the wash-in perfusion index were significantly different between the groups. No significant differences were found between rise time, mean transit time, and time to peak. For the ANN, sensitivity was 94.64%, specificity 94.44%, PPV 97.24%, and NPV 89.47%.
  
  
  CONCLUSIONS
  Only PC and CP lesions were included.
  
  
  CONCLUSIONS
  Parameters obtained through TIC analysis can differentiate between PC and CP cases and can be used in an automated computer-aided diagnostic system with good diagnostic results. (
  
  
  BACKGROUND
  NCT01315548.).
authors: Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy, Craiova, Romania; Endoscopy Department, Copenhagen University Hospital, Herlev, Denmark.
authors: Adrian
authors: A
authors: Săftoiu
authors: Endoscopy Department, Copenhagen University Hospital, Herlev, Denmark.
authors: Peter
authors: P
authors: Vilmann
authors: Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Medical D 2, Caritas-Krankenhaus Bad, Mergentheim, Germany.
authors: Christoph F
authors: CF
authors: Dietrich
authors: Gastroenterology Department, University Hospital Santiago de Compostela, Coruña, Spain.
authors: Julio
authors: J
authors: Iglesias-Garcia
authors: Internal Medicine II, Hospital Meiningen, Meiningen, Germany.
authors: Michael
authors: M
authors: Hocke
authors: Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Iuliu Haţieganu" Cluj-Napoca, Romania.
authors: Andrada
authors: A
authors: Seicean
authors: Medical D 2, Caritas-Krankenhaus Bad, Mergentheim, Germany.
authors: Andre
authors: A
authors: Ignee
authors: Endoscopy Department, Copenhagen University Hospital, Herlev, Denmark.
authors: Hazem
authors: H
authors: Hassan
authors: Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy, Craiova, Romania.
authors: Costin Teodor
authors: CT
authors: Streba
authors: Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy, Craiova, Romania.
authors: Ana Maria
authors: AM
authors: Ioncică
authors: Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy, Craiova, Romania.
authors: Dan Ionuţ
authors: DI
authors: Gheonea
authors: Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy, Craiova, Romania.
authors: Tudorel
authors: T
authors: Ciurea
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016571:Neural Networks, Computer; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media