Quantitative evaluation of pancreatic tumor fibrosis using shear wave elastography.
OBJECTIVE
There is no established non-invasive method for diagnosis of pancreatic fibrosis. Shear wave elastography (SW-EG) may be a candidate for this purpose. The aims of this study were to assess the reproducibility of SW-EG in the normal imaging pancreas (Phase 1) and to evaluate the diagnostic performance of SW-EG for pancreatic fibrosis classified histologically (Phase 2).


METHODS
Phase 1: This included 127 cases that underwent SW-EG of the normal imaging pancreas. SW-EG was measured at least five times in the pancreatic parenchyma and the median of repeated measurements was defined as the pancreatic elastic modulus (PEM). Phase 2: This included 53 cases that underwent SW-EG of the pancreatic parenchyma preoperatively and in which pancreas parenchyma were evaluated histologically. Histological fibrosis was graded in 4 stages: normal, mild, moderate, and severe.


RESULTS
Phase 1: Median PEM in the head, body, and tail of the pancreas were 3.23, 3.17, and 2.91 kPa, respectively, with no significant difference among regions (P = 0.554). The intraclass correlation coefficient showed good reproducibility (ρ = 0.71) after 5 measurements. Phase 2: There was a significant positive correlation between PEM and the histological pancreatic fibrosis stage (rs= 0.63, P < 0.001). Areas under the receiver operating characteristic curve for the accuracy of SW-EG for diagnosis of pancreatic fibrosis were 0.85 (≥mild), 0.84 (≥moderate), and 0.87 (severe).


CONCLUSIONS
SW-EG can be used to determine the stage of pancreatic fibrosis non-invasively with high accuracy and reproducibility.
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Takamichi
T
Kuwahara
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan. Electronic address: hirooka@med.nagoya-u.ac.jp.
Yoshiki
Y
Hirooka
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hiroki
H
Kawashima
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Eizaburo
E
Ohno
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hiroyuki
H
Sugimoto
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Daijuro
D
Hayashi
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Tomomasa
T
Morishima
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Manabu
M
Kawai
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hiroki
H
Suhara
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Tomoaki
T
Takeyama
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
Takeshi
T
Yamamura
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
Kohei
K
Funasaka
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Masanao
M
Nakamura
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ryoji
R
Miyahara
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Osamu
O
Watanabe
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Masatoshi
M
Ishigami
Department of Pathology and Molecular Diagnostics, Nagoya University Hospital, Nagoya, Japan.
Yoshie
Y
Shimoyama
Department of Pathology and Molecular Diagnostics, Nagoya University Hospital, Nagoya, Japan.
Shigeo
S
Nakamura
Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Toyoake, Japan.
Senju
S
Hashimoto
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hidemi
H
Goto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000473:pathology; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
Chronic pancreatitis; Pancreas; Pancreatic fibrosis; Shear wave elastography