Endoscopy 2011; 43 - A98
DOI: 10.1055/s-0031-1292169

Study on contrast enhanced EUS in pancreatic disease

Zhu Qi 1, Gong Ting-ting 1, Xiong Hui-fang 1, Zhang Yi 1, Sun Yun-wei 1, Tan Ji-hong 1, Xia Lu 1
  • 1Department of Gastroenterology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Background: The differenzial diagnosis of pancreatic disease is still crucial. Invasive measures which can obtain tissue samples have high specificity. However, contrast-enhanced endoscopic ultrasonography (CE-EUS) may offer a non-invasive option and better visualization.

Objective: To investigate the feasibility and role of CE-EUS in the diagnosis of pancreatic disease, and to describe the characteristics of enhancement of the normal pancreas and the pancreas affected by inflammation or focal disease.

Design: Prospective single-center study

Patients: The study includes two groups (a total of 115 patients): one group for qualitative analysis (46 patients with focal pancreatic lesions, 8 patients with chronic pancreatitis, and 10 patients with normal pancreas as controls); the other group for quantitative analysis (26 patients with focal pancreatic lesions, 6 patients with chronic pancreatitis, and 19 patients with normal pancreas).

Interventions: CE-EUS was performed by using a radial/linear echoendoscope and electrical EUS system. The second generation contrast enhancer SonoVue® was used. Representative loops of at least 90 seconds were recorded in each targeted region of interest. A postprocessing software was used for quantitative analysis.

Results: Normal pancreas presented a relatively homogeneous punctiform or claviform (Type I, II) enhancement and degree II-III enhancement intensity, the value of PI was 0.648±0.174. Chronic pancreatitis presented a relatively heterogenous claviform or plaquelike (Type II, III) enhancement and degree III-IV enhancement intensity, the value of PI was 0.772±0.106. Pancreatic cancer presented a relatively heterogenous punctiform or claviform (Type I, II) enhancement, most of the focal lesions demonstrated slow filling-in and rapid wash-out enhancement phase, the focal lesions presented degree I-II enhancement intensity, the value of PI was 0.321±0.119. Based on a cutoff of 0.505, the sensitivity, specificity, PPV, NPV and accuracy of differentiation of normal pancreas and pancreatic cancer were 100%, 84.2%, 82.4%, 100%, 90.9%, respectively. Pancreatic cyst presented non-enhanced blood flow in the cyst, the value of PI was 0.181±0.036 and the TIC was a linear. Based on a cutoff of 0.195, the sensitivity, specificity, PPV, NPV and accuracy of differentiation of pancreatic cancer and pancreatic cyst were 85.7%, 87.5%, 92.3%, 77.8%, 86.4% respectively. Pancreatic endocrine tumors presented plaquelike (Type III) enhancement and degree III-IV enhancement intensity, most of the lesions demonstrated rapid filling-in and rapid wash-out enhancement phase, and the value of PI was 0.763±0.115.

Conclusions: CE-EUS is a promising method that allows characterization of normal pancreatic parenchyma and pancreatic tissue affected by chronic inflammatory or various focal diseases. Future study for more reliable criteria to differentiate pancreatic disease is important for introducing this method into clinical practice.