Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer

Abstract

Aim: To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels.

Methods: In 86 patients with suspected chronic pancreatitis (age: 62+/-12 years; sex: f/m 38/48), pancreatic lesions were examined by conventional endoscopic B-mode, power Doppler ultrasound and contrast-enhanced power mode (Hitachi EUB 525, SonoVue, 2.4 mL, Bracco) using the following criteria for malignant lesions: no detectable vascularisation using conventional power Doppler scanning, irregular appearance of arterial vessels over a short distance using SonoVue contrast-enhanced technique and no detectable venous vessels inside the lesion. A malignant lesion was assumed if all criteria were detectable [gold standard endoscopic ultrasound (EUS)-guided fine needle aspiration cytology, operation]. The criteria of chronic pancreatitis without neoplasia were defined as no detectable vascularisation before injection of SonoVue, regular appearance of vessels over a distance of at least 20 mm after injection of SonoVue and detection of arterial and venous vessels.

Results: The sensitivity and specificity of conventional EUS were 73.2% and 83.3% respectively for pancreatic cancer. The sensitivity of contrast-enhanced EUS increased to 91.1% in 51 of 56 patients with malignant pancreatic lesion and the specificity increased to 93.3% in 28 of 30 patients with chronic inflammatory pancreatic disease.

Conclusion: Contrast-enhanced endoscopic ultrasound improves the differentiation between chronic pancreatitis and pancreatic carcinoma.

Figures

Figure 1

Endoscopic ultrasound image of chronic panreatitis. Regular vascularisation is shown with detection of venous vessels using contrast-enhanced power Doppler scanning in combination with power Doppler.

Figure 2

Endoscopic ultrasound image of ductal adenocarcinoma of the pancreas. Irregular vascularisation is shown with detection of only arterial and no venous vessels using contrast-enhanced power Doppler scanning in combination with pw-Doppler.

Figure 3

Results of contrast-enhanced endoscopic ultrasound in differentiation between pancreatic carcinoma and focal pancreatitis.