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Journal of Gastroenterology

, Volume 47, Issue 4, pp 427–432 | Cite as

Acoustic radiation force impulse elastography for noninvasive assessment of chronic pancreatitis

  • Yoko Yashima
  • Naoki SasahiraEmail author
  • Hiroyuki Isayama
  • Hirofumi Kogure
  • Hitoshi Ikeda
  • Kenji Hirano
  • Suguru Mizuno
  • Hiroshi Yagioka
  • Kazumichi Kawakubo
  • Takashi Sasaki
  • Yousuke Nakai
  • Minoru Tada
  • Haruhiko Yoshida
  • Masao Omata
  • Kazuhiko Koike
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

Endoscopic ultrasonography or real-time elastography has been applied for the diagnosis of chronic pancreatitis. Acoustic radiation force impulse (ARFI) imaging is another tissue strain imaging technology, and recent technological advances have enabled quantification of the stiffness of some tissues by measuring the shear wave velocity (SWV) during routine B-mode ultrasonography.

Methods

ARFI elastography was performed in 52 healthy volunteers and 46 patients with chronic pancreatitis. SWV was measured in the head, body, and tail of the pancreas. The diagnostic performance was assessed using receiver-operating characteristic (ROC) curves.

Results

SWV in patients with chronic pancreatitis was significantly higher than that in healthy volunteers in each part of the pancreas, although the measurement was difficult in the tail of the pancreas. The area under the ROC curve was 0.78 in the body of the pancreas, with an optimal cut-off value of 1.40 m/s, and the sensitivity, specificity, positive predictive value, and negative predictive value were 75, 72, 69, and 78%, respectively. In the patients with chronic pancreatitis, alcoholic etiology and decreased body mass index (BMI) were associated with high SWV.

Conclusions

ARFI elastography of the pancreas showed high elasticity in chronic pancreatitis compared to findings in the normal pancreas. This modality is feasible to use for the diagnosis of chronic pancreatitis.

Keywords

Acoustic radiation force impulse Chronic pancreatitis Pancreatic elasticity 

Notes

Conflict of interest

None.

References

  1. 1.
    Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med. 1995;332:1482–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P. EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study. Gastrointest Endosc. 2002;55:507–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Catalano MF, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69:1251–61.PubMedCrossRefGoogle Scholar
  4. 4.
    Wallace MB, Hawes RH, Durkalski V, Chak A, Mallery S, Catalano MF, et al. The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers. Gastrointest Endosc. 2001;53:294–9.PubMedGoogle Scholar
  5. 5.
    Stevens T, Lopez R, Adler DG, Al-Haddad MA, Conway J, Dewitt JM, et al. Multicenter comparison of the interobserver agreement of standard EUS scoring and Rosemont classification scoring for diagnosis of chronic pancreatitis. Gastrointest Endosc. 2010;71:519–26.Google Scholar
  6. 6.
    Cespedes I, Ophir J, Ponnekanti H, Maklad N. Elastography: elasticity imaging using ultrasound with application to muscle and breast in vivo. Ultrason Imaging. 1993;15:73–88.PubMedCrossRefGoogle Scholar
  7. 7.
    Konig K, Scheipers U, Pesavento A, Lorenz A, Ermert H, Senge T. Initial experiences with real-time elastography guided biopsies of the prostate. J Urol. 2005;174:115–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Uchida H, Hirooka Y, Itoh A, Kawashima H, Hara K, Nonogaki K, et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas. 2009;38:17–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Janssen J, Dietrich CF, Will U, Greiner L. Endosonographic elastography in the diagnosis of mediastinal lymph nodes. Endoscopy. 2007;39:952–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–13.PubMedCrossRefGoogle Scholar
  11. 11.
    Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128:343–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Nightingale KR, Palmeri ML, Nightingale RW, Trahey GE. On the feasibility of remote palpation using acoustic radiation force. J Acoust Soc Am. 2001;110:625–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Nightingale K, Soo MS, Nightingale R, Trahey G. Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibility. Ultrasound Med Biol. 2002;28:227–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Friedrich-Rust M, Wunder K, Kriener S, Sotoudeh F, Richter S, Bojunga J, et al. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology. 2009;252:595–604.PubMedCrossRefGoogle Scholar
  15. 15.
    Sarvazyan AP, Rudenko OV, Swanson SD, Fowlkes JB, Emelianov SY. Shear wave elasticity imaging: a new ultrasonic technology of medical diagnostics. Ultrasound Med Biol. 1998;24:1419–35.PubMedCrossRefGoogle Scholar
  16. 16.
    Nightingale K, McAleavey S, Trahey G. Shear-wave generation using acoustic radiation force: in vivo and ex vivo results. Ultrasound Med Biol. 2003;29:1715–23.PubMedCrossRefGoogle Scholar
  17. 17.
    Sarner M, Cotton PB. Classification of pancreatitis. Gut. 1984;25:756–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Fahey BJ, Nightingale KR, Nelson RC, Palmeri ML, Trahey GE. Acoustic radiation force impulse imaging of the abdomen: demonstration of feasibility and utility. Ultrasound Med Biol. 2005;31:1185–98.PubMedCrossRefGoogle Scholar
  19. 19.
    Braganza JM, Hunt LP, Warwick F. Relationship between pancreatic exocrine function and ductal morphology in chronic pancreatitis. Gastroenterology. 1982;82:1341–7.PubMedGoogle Scholar
  20. 20.
    Ammann RW, Buehler H, Muench R, Freiburghaus AW, Siegenthaler W. Differences in the natural history of idiopathic (nonalcoholic) and alcoholic chronic pancreatitis. A comparative long-term study of 287 patients. Pancreas. 1987;2:368–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Masuzaki R, Tateishi R, Yoshida H, Goto E, Sato T, Ohki T, et al. Prospective risk assessment for hepatocellular carcinoma development in patients with chronic hepatitis C by transient elastography. Hepatology. 2009;49:1954–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Foucher J, Chanteloup E, Vergniol J, Castera L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006;55:403–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Lowenfels AB, Maisonneuve P, Cavallini G, Ammann RW, Lankisch PG, Andersen JR, et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med. 1993;328:1433–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Malka D, Hammel P, Maire F, Rufat P, Madeira I, Pessione F, et al. Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut. 2002;51:849–52.PubMedCrossRefGoogle Scholar
  25. 25.
    Cremer M, Deviere J, Delhaye M, Baize M, Vandermeeren A. Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients. Endoscopy. 1991;23:171–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Delhaye M, Vandermeeren A, Baize M, Cremer M. Extracorporeal shock-wave lithotripsy of pancreatic calculi. Gastroenterology. 1992;102:610–20.PubMedGoogle Scholar
  27. 27.
    Sasahira N, Tada M, Isayama H, Hirano K, Nakai Y, Yamamoto N, et al. Outcomes after clearance of pancreatic stones with or without pancreatic stenting. J Gastroenterol. 2007;42:63–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Yoko Yashima
    • 1
  • Naoki Sasahira
    • 1
    Email author
  • Hiroyuki Isayama
    • 1
  • Hirofumi Kogure
    • 1
  • Hitoshi Ikeda
    • 1
  • Kenji Hirano
    • 1
  • Suguru Mizuno
    • 1
  • Hiroshi Yagioka
    • 1
  • Kazumichi Kawakubo
    • 1
  • Takashi Sasaki
    • 1
  • Yousuke Nakai
    • 1
  • Minoru Tada
    • 1
  • Haruhiko Yoshida
    • 1
  • Masao Omata
    • 1
  • Kazuhiko Koike
    • 1
  1. 1.Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan

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