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Contrast‐enhanced harmonic endoscopic ultrasonography for pancreatobiliary diseases
Author(s) -
Kitano Masayuki,
Kamata Ken,
Imai Hajime,
Miyata Takeshi,
Yasukawa Satoru,
Yanagisawa Akio,
Kudo Masatoshi
Publication year - 2015
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12454
Subject(s) - medicine , pancreatic duct , radiology , pancreas , endoscopic ultrasound , microbubbles , parenchyma , adenocarcinoma , endoscopic ultrasonography , bile duct , ultrasound , endoscopy , pathology , cancer
The combination of second‐generation ultrasound contrast agents and an endoscopic ultrasonography ( EUS ) system with a broad‐band transducer has allowed contrast‐enhanced harmonic imaging in the field of EUS . In contrast‐enhanced harmonic EUS ( CH‐EUS ), diffuse homogeneous enhancement is obtained in normal parenchyma of the pancreas. The bile duct and pancreatic duct are depicted as non‐enhanced ductal structures with strong contrast in comparison to the surrounding parenchyma. CH‐EUS identifies pancreatic adenocarcinomas as solid lesions exhibiting hypo‐enhancement with a sensitivity and specificity of 88–96% and 88–94%, respectively. In particular, 80–100% of false‐negative cases in endoscopic ultrasound‐guided fine‐needle aspiration ( EUS‐FNA ) are correctly classified by CH‐EUS , suggesting CH‐EUS complements EUS‐FNA . Moreover, CH‐EUS improves depiction of some subtle lesions in conventional EUS , thus facilitating EUS‐FNA . For quantitative perfusion analysis, a time–intensity curve ( TIC ) for the region of interest can be generated during CH‐EUS . The maximum intensity gain and the echo intensity reduction rate from the peak at 1 min obtained by TIC can be used for differentiation of pancreatic adenocarcinoma from other tumors. CH‐EUS is also useful for differentiation of invasive intraductal papillary mucinous neoplasms ( IPMN ) from non‐invasive IPMN , identification of malignant lesions in the gallbladder, and T ‐ and N ‐staging of pancreatobiliary tumors.