Objective Fine Vessel Assessment using a Novel Endoscopic Ultrasound Detective Flow Imaging-based Computer Vision Software to Differentiate Between Normal and Abnormal (Acute, Chronic and Pancreatic Steatosis) Pancreas: a Pilot Study

Aims Detective flow imaging (DFI) is a relatively new endoscopic ultrasound (EUS) imaging technology helpful in the visualization of fine vessels (FV) with low velocities in the absence of motion artefacts. Microvasculature changes have been seen in acute pancreatitis (AP) and chronic pancreatitis (CP). Until now, DFI FV detection has been measured subjective, based on the visual impression of the endoscopists. In the present study, we developed a computer vision (CV) software(mdconsgroup, Guayaquil, Ecuador) aimed to provide an average number of FVobserved during EUS-DFI and the maximum number of FV detected, to establish an objective measurement for DFI evaluation. In the present study, we aimed to establish a cut-off value of the number of FVs detected through the CV software to differentiate between normal (NP) and abnormal pancreas (AP, CP, and pancreatic steatosis (PS)) [1].

Methods A single-centre, observational, prospective, pilot study was performed at the Instituto Ecuatoriano de Enfermedades Digestivas, Ecuador. Four cohorts (NP, AP, CP, and PS) were included in the study. Patients over 18 years old who required EUS evaluation underwent EUS-DFI assessment. A p-value 'lt;.05 will be considered statistically significant.

Results A total of 25 patients were included in the study. The mean age was 54.7 (+ /-16.4) and 17/25 (68%) were female. Among the included patients, 6/25 (24%) hadnormal pancreas observed during EUS, 5/25 (20%) had PS, 3/25 (12%) had AP, 7/25(28%) had CP, and 4/25 (16%) had mass-forming CP. FV were observed in 14/25patients (56%). The median number of FV observed in NP was 7 (5.5-13), whereas themedian number of FV in abnormal pancreas was 16 (15.5-17.5). The median number ofFV observed for PS, AP and CP were 15 (14.5-15.5), 17.5 (17.3-17.8), and 16 (15.5-17.5), respectively (p=.505). The median maximum number of FV observed duringEUS-DFI evaluation was 36.0 (35.5-42.0) for NP, 28 (27.5-28.5) for PS, 40.5 (34.3-46.8) for AP, and 40 (36.5-42.5) for CP. A cut-off value was determined at 10 for theaverage of fine vessels observed during EUS-DFI, achieving a sensitivity, specificity,PPV, NPV, and observed agreement of 100%, 67.0%, 92.0%, 100%, and 93.0%,respectively. The software obtained an area under the receiver operator curve (AUROC)of 0.682 to differentiate between normal and abnormal pancreas.

Conclusions In the present pilot study, the DFI-EUS-based CV software was capable todifferentiate between normal pancreas and abnormal pancreas with high observedagreement. There was no difference between AP, CP and PS regarding the averagenumber of FV.

 

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Conflicts of Interest

Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, EndoSound, and mdconsgroup. All other authors have nothing to declare.

• References

• 1 Pitkäranta P, Kivisaari L, Nordling S, Nuutinen P, Schroder T.. Vascular changes of pancreatic ducts and vessels in acute necrotizing, and in chronic pancreatitis in humans. Int J Pancreatol 1991; 8 (01): 13-22 PMID: 2033315

Publication History

Article published online:
27 March 2025