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patients with autoimmune pancreatitis show typical signs of hypervascularization in contrast-enhanced high mechanical index endoscopic ultrasound (CEHMI EUS) [1]. Contrast-enhanced low mechanical index endoscopic ultrasound (CELMI EUS) is a newly developed technique that should show a different contrast-enhancing effect. To explore the effect of CEHMI EUS (picture acquisition●" Fig. 1a and 1b) and CELMI EUS, we further combined each technique with the newly developed method of three-dimensional (3D) endosonography. 3D endosonography has already been shown to improve the visualization of unenhanced gastrointestinal structures [2], and has recently been performed in combinationwith CELMI EUS [3]. However, 3D endosonography has not previously been done in association with CEHMI EUS or in patients with autoimmune pancreatitis. We used the commercial platform of the Hitachi Preirus ultrasound machine in connection with a longitudinal endosonography scanner from Pentax. CEHMI EUS was performed as recently described [4]. CELMI EUSwas performedwith an additional injection of 4.5mL Sonovue after the CEHMI EUS data acquisition. A 3D scan was donewith eachmethod 30–40 s after injection of the contrast enhancer. The difference in vascularization with autoimmune pancreatitis compared with that in a normal pancreas was impressively shown using the 3D CEHMI EUS technique.●" Fig. 1a,b show images acquired during3DCEHMIEUS, in apatientwith autoimmune pancreatitis and from a normal pancreas, and ●" Fig. 2a,b show the 3D reconstructions. Furthermore, 3D CELMI EUS (●" Fig. 2c,d) also provided a striking improvement in the contrast-enhancing effect in the pancreatic tissue.

Three-dimensional contrast-enhanced endoscopic ultrasound for the diagnosis of autoimmune pancreatitis