title: Doppler tissue perfusion parameters in recognizing pancreatic malignant tumors.
abstract: BACKGROUND
  Histopathology, radiological imaging methods with the administration of contrast agents are efficient to differentiate focal lesions of the pancreas. Invasiveness, contrast toxicity, and limited accessibility ameliorate their application. Noninvasive and contrast-agent-free method could improve diagnostics and accelerate treatment.
  
  
  OBJECTIVE
  The aim of the study is to evaluate the diagnostic properties of ultrasound parameters of organ perfusion in the detection of malignant tumors of the pancreas.
  
  
  METHODS
  Thirty-six patients with a focal lesion of the pancreas underwent endosonography with color flow imaging and biopsy for histological evaluation. Five patients were excluded because of the absence of the Doppler signal in pancreatic lesion. In the dynamic tissue perfusion measurement (DTPM) means of flow velocity (FV), resistive index, pulsatility index, and perfusion relief intensity (PR) were estimated.
  
  
  RESULTS
  In the group with malignant tumors FV was significantly lower compared with the group with inflammatory changes. In receiver operating characteristic (ROC) analysis FV below the optimal cut-off point of 2.382 cm/s identified patients with malignant lesions with a sensitivity of 92% and specificity of 90%. In the group with malignant tumors significantly lower values of PR in all considered percentiles were observed. Based on the ROC analysis in the group with solid tumors, it was found that PR25 ≤ 0.057 allowed to recognize malignancies with a sensitivity of 100% and specificity of 80%, and in the groups with solid and cystic tumors with a sensitivity of 100% and specificity of 79%.
  
  
  CONCLUSIONS
  FV and PR intensity derived from DTPM are reliable markers in recognition of pancreatic malignant masses.
authors.affiliation: Department of Gastroenterology, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Przemysław
authors.initials: P
authors.lastname: Dyrla
authors.affiliation: Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Lubas
authors.affiliation: Department of Gastroenterology, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Gil
authors.affiliation: Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Niemczyk
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D003287:Contrast Media; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: cancers: biology; diagnosis and therapy < gastroenterology; endoscopic ultrasound < gastroenterology; pancreatic cancer < gastroenterology