title: Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography.
abstract: OBJECTIVE
  To elucidate the role of contrast-enhanced endoscopic ultrasonography (CE-EUS) in the diagnosis of branch duct intraductal papillary mucinous neoplasm (BD-IPMN).
  
  
  METHODS
  A total of 50 patients diagnosed with BD-IPMN by computed tomography (CT) and endoscopic ultrasonography (EUS) at our institute were included in this study. CE-EUS was performed when mural lesions were detected by EUS. The diagnostic accuracy for identifying mural nodules (MNs) was evaluated by CT, EUS, and EUS combined with CE-EUS. In the patients who underwent resection, the accuracy of measuring MN height with each imaging modality was compared. The cut-off values to diagnose malignant BD-IPMNs based on MN height for each imaging modality were determined using receiver operating characteristic curve analysis.
  
  
  RESULTS
  Fifteen patients were diagnosed with BD-IPMN with MNs and underwent resection. The remaining 35 patients were diagnosed with BD-IPMN without MNs and underwent follow-up monitoring. The pathological findings revealed 14 cases with MNs and one case without. The accuracy for diagnosing MNs was 92% using CT and 72% using EUS; the diagnostic accuracy increased to 98% when EUS and CE-EUS were combined. The accuracy for measuring MN height significantly improved when using CE-EUS compared with using CT or EUS (median measurement error value, CT: 3.3 mm vs CE-EUS: 0.6 mm, P < 0.05; EUS: 2.1 mm vs CE-EUS: 0.6 mm, P < 0.01). A cut-off value of 8.8 mm for MN height as measured by CE-EUS improved the accuracy of diagnosing malignant BD-IPMN to 93%.
  
  
  CONCLUSIONS
  Using CE-EUS to measure MN height provides a highly accurate method for differentiating benign from malignant BD-IPMN.
authors.affiliation: Hirofumi Harima, Seiji Kaino, Shuhei Shinoda, Michitaka Kawano, Shigeyuki Suenaga, Isao Sakaida, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Harima
authors.affiliation: Hirofumi Harima, Seiji Kaino, Shuhei Shinoda, Michitaka Kawano, Shigeyuki Suenaga, Isao Sakaida, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kaino
authors.affiliation: Hirofumi Harima, Seiji Kaino, Shuhei Shinoda, Michitaka Kawano, Shigeyuki Suenaga, Isao Sakaida, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Shinoda
authors.affiliation: Hirofumi Harima, Seiji Kaino, Shuhei Shinoda, Michitaka Kawano, Shigeyuki Suenaga, Isao Sakaida, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan.
authors.forename: Michitaka
authors.initials: M
authors.lastname: Kawano
authors.affiliation: Hirofumi Harima, Seiji Kaino, Shuhei Shinoda, Michitaka Kawano, Shigeyuki Suenaga, Isao Sakaida, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Suenaga
authors.affiliation: Hirofumi Harima, Seiji Kaino, Shuhei Shinoda, Michitaka Kawano, Shigeyuki Suenaga, Isao Sakaida, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Sakaida
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000368:Aged; D019540:Area Under Curve; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007501:Iron; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010087:Oxides; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D057832:Watchful Waiting
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron
keywords: Branch duct intraductal papillary mucinous neoplasm; Computed tomography; Contrast-enhanced endoscopic ultrasonography; Endoscopic ultrasonography; Mural nodules