Basic Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 14, 2006; 12(2): 246-250
Published online Jan 14, 2006. doi: 10.3748/wjg.v12.i2.246
Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer
Michael Hocke, Ewald Schulze, Peter Gottschalk, Theodor Topalidis, Christoph F Dietrich
Michael Hocke, Peter Gottschalk, Department of Internal Medicine II, Friedrich Schiller University Jena, Erlanger Allee 101, 07740 Jena, Germany
Ewald Schulze, Department of Pathology, Friedrich Schiller University Jena, Erlanger Allee 101, 07740 Jena, Germany
Theodor Topalidis, Cytologic Institute, Doehrbruch 62, 30559 Hannover, Germany
Christoph F Dietrich, Caritas Hospital, Department of Internal Medicine II, Uhlandstraße 7, 97980 Bad Mergentheim, Germany
Co-first-author: Michael Hocke and Christoph F Dietrich
Co-correspondence: Christoph F Dietrich
Correspondence to: Dr. Michael Hocke, Department of Internal Medicine II, Friedrich Schiller University Jena, Erlanger Allee 101, 07740 Jena, Germany. Michael.hocke@med.uni-jena.de
Telephone: +493641-9322300 Fax: +493641-9322332
Received: May 17, 2005
Revised: June 28, 2005
Accepted: July 8, 2005
Published online: January 14, 2006
Abstract

AIM: To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels.

METHODS: In 86 patients with suspected chronic pancreatitis (age: 62 ± 12 years; sex: f/m 38/48), pancreatic lesions were examined by conventional endoscopic B-mode, power Doppler ultrasound and contrast-enhanced power mode (Hitachi EUB 525, SonoVue®, 2.4 mL, 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 detectable venous vessels inside the lesion. A malignant lesion was assumed if all criteria were detectable [gold standard endoscopic ultrasound (EUS)-guided fine needle aspiration cytology, operation]. The criteria of chronic pancreatitis without neoplasia were defined as no detectable vascularisation before injection of SonoVue®, regular appearance of vessels over a distance of at least 20 mm after injection of SonoVue® and detection of arterial and venous vessels.

RESULTS: The sensitivity and specificity of conventional EUS were 73.2% and 83.3% respectively for pancreatic cancer. The sensitivity of contrast-enhanced EUS increased to 91.1% in 51 of 56 patients with malignant pancreatic lesion and the specificity increased to 93.3% in 28 of 30 patients with chronic inflammatory pancreatic disease.

CONCLUSION: Contrast-enhanced endoscopic ultrasound improves the differentiation between chronic pancreatitis and pancreatic carcinoma.

Keywords: Endoscopic ultrasound; Contrast enhancer; Chronic pancreatitis; Pancreatic cancer