title: Contrast-Enhanced Endoscopic Ultrasonography for Pancreatic Tumors.
abstract: OBJECTIVE
  To investigate the usefulness of contrast-enhanced endoscopic ultrasonography (CE-EUS) for histological differentiation of pancreatic tumors.
  
  
  METHODS
  CE-EUS was performed for consecutive patients having a pancreatic solid lesion, and tumors were classified into three vascular patterns (hypervascular, isovascular, and hypovascular) at two time phases (early-phase and late-phase). Correlation between vascular patterns and histopathology of resected pancreatic cancer (PC) tissues was ascertained.
  
  
  RESULTS
  The final diagnoses of 147 examined tumors were PC (n = 109), inflammatory mass (n = 11), autoimmune pancreatitis (n = 9), neuroendocrine tumor (n = 8), and others (n = 10). In late-phase images, 104 of 109 PCs had the hypovascular pattern, for a diagnostic sensitivity and specificity of 94% and 71%, respectively. Of 28 resected PCs, 10 had isovascular, and 18 hypovascular, patterns on the early-phase image. Early-phase isovascular PCs were more likely to be differentiated than were early-phase hypovascular PCs (6 well and 4 moderately differentiated versus 3 well, 14 moderately, and 1 poorly differentiated, P = 0.028). Immunostaining revealed that hypovascular areas of early-phase images reflected heterogeneous tumor cells with fibrous tissue, necrosis, and few vessels.
  
  
  CONCLUSIONS
  CE-EUS could be useful for distinguishing PC from other solid pancreatic lesions and for histological differentiation of PCs.
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Yasunobu
authors.identifier: 0000-0002-6725-5708
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Jun
authors.identifier: 0000-0002-1869-2135
authors.initials: J
authors.lastname: Kato
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Division of Pathology, Department of Clinical Laboratory Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kawaji
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Abe
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Nuta
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Itonaga
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Takeichi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Hideyuki
authors.identifier: 0000-0003-4511-4573
authors.initials: H
authors.lastname: Tamai
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003287:Contrast Media / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D003287:Contrast Media