Aim: The aim of this study was to evaluate contrast-enhanced endosonography as a method
of differentiating inflammation and pancreatic carcinoma based on perfusion characteristics
of microvessels. Patients and
Method: In 192 patients with suspected chronic pancreatitis [age: 64±11 years; sex: f/m 75/117]
pancreatic lesions were examined by conventional endoscopic B-mode and Power Doppler
ultrasound and contrast enhanced power mode (Hitachi EUB 525, SonoVue®, 2.4ml, 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 detection
of venous vessels inside the lesion. A malignant lesion was assumed if all criteria
were detectable (gold standard EUS-guided fine needle aspiration cytology, operation).
The criteria of chronic pancreatitis without neoplasia were defined as no detectable
vascularisation before injection, regular appearance of vessels over a distance of
at least 20mm after injection of SonoVue® and detection of arterial and venous vessels.
Results: Using conventional EUS-criteria sensitivity was 82.2% and specificity of 87.8% for
pancreatic cancer. Using contrast enhanced EUS 108 of 118 patients with malignant
pancreatic lesion revealed all criteria (increasing sensitivity to 91.5%). In 70 of
74 patients (specificity 94.6%) with chronic pancreatitis the diagnosis was correctly
recognized.
