title: Contrast Harmonic-Endoscopic Ultrasound Is Useful to Identify Neoplastic Features of Pancreatic Cysts (With Videos).
abstract: OBJECTIVE
  To evaluate the potential role of contrast harmonic endoscopic ultrasound (CH-EUS) in the differential diagnosis of pancreatic cysts and detection of malignancy.
  
  
  METHODS
  Patients who underwent CH-EUS for evaluation of cyst wall, septae, and solid components of pancreatic cysts were included. The findings were compared to fine needle aspiration and surgery.
  
  
  RESULTS
  Seventy-six patients were included. Serous and mucinous cysts were both hyperenhanced (86% and 89%, respectively; P = ns), whereas pseudocysts were hypoenhanced in 90% of the cases (P = 0.000004 vs serous cysts and P = 0.000005 vs mucinous cysts). Patients showing hyperenhanced solid components were finally diagnosed with malignancy (2 malignant intraductal papillary mucinous neoplasms, 2 cystic neuroendocrine tumors), in contrast to the patients with nonenhanced solid components who resulted to have either benign cysts with internal mucus clots (n = 10) or pseudocysts with internal debris (n = 8).
  
  
  CONCLUSIONS
  CH-EUS allowed differentiation between pseudocysts and other pancreatic cysts but not mucinous versus serous cysts. Malignant vegetations inside pancreatic cystic lesions were clearly shown by CH-EUS as solid components with features of hyperenhancement, directing EUS-fine needle aspiration of potential neoplastic areas and avoiding puncture of debris and mucus plugs.
authors.affiliation: From the *Gastrointestinal Unit, Department of Medical and Surgical Sciences, Imola Hospital, and †Internal Medicine Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Fusaroli
authors.forename: Marta
authors.initials: M
authors.lastname: Serrani
authors.forename: Roberto
authors.initials: R
authors.lastname: De Giorgio
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: D'Ercole
authors.forename: Liza
authors.initials: L
authors.lastname: Ceroni
authors.forename: Andrea
authors.initials: A
authors.lastname: Lisotti
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Caletti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D018291:Cystadenoma, Mucinous / Q000175:diagnosis / Q000473:pathology; D018293:Cystadenoma, Serous / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000473:pathology; D010179:Pancreas / Q000473:pathology; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010192:Pancreatic Pseudocyst / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media