Der Gastroenterologe

, Volume 8, Issue 2, pp 118–126 | Cite as

Endosonographische Optionen in der Pankreasdiagnostik

Standards und neue Entwicklungen
Schwerpunkt
  • 226 Downloads

Zusammenfassung

Pathologische Veränderungen des Pankreas weisen initial oft unspezifische Symptome auf. Der endoskopische Ultraschall stellt eine unverzichtbare Methode zur sicheren Differenzierung der verschiedenen Krankheiten des Pankreas dar. Neue Bildbearbeitungsmethoden wie der kontrastmittelverstärkte endoskopische Ultraschall, die Real-Time-Elastographie und 3-D-Rekonstruktionen werden möglicherweise das Spektrum der diagnostischen Möglichkeiten erweitern und die Sicherheit in der Differenzierung der krankhaften Veränderungen des Pankreas durch den endoskopischen Ultraschall erhöhen.

Schlüsselwörter

Endosonographie Bildbearbeitungsmethoden Elastographie 3-D-Rekonstruktion Pankreasdiagnostik 

Abkürzungsverzeichnis

AIP

Autoimmunpankreatitis

CE-EUS

Kontrastverstärkter endoskopischer Ultraschall

ERCP

Endoskopische retrograde Cholangiopankreatikographie

EUS

Endosonographischer Ultraschall

EUS-FNA

EUS-Feinnadelaspiration

IPMN

Intraduktale papillär-muzinöse Neoplasie

MCN

Muzinös-zystische Neoplasie

NPV

Negativ-prädiktiver Wert

PPV

Positiv-prädiktiver Wert

SCN

Serös-zystische Neoplasie

Options in endosonographic examination of the pancreas

Standards and new techniques

Abstract

Frequently, pathological changes of the pancreas initially show unspecific symptoms. Endoscopic ultrasound represents an indispensable method to reliably distinguish the different forms of pancreatic diseases. New methods in image processing, e.g. contrast-enhanced endoscopic ultrasound, real-time elastography and 3D reconstruction may enlarge the spectrum of diagnostic possibilities and increase the reliability of differentiating pathologic changes of the pancreas by endoscopic ultrasound.

Keywords

Endosonography Image processing techniques Elastography 3D reconstruction Pancreas diagnostics 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Adet A, Miquel R, Bombi JA et al (2010) Incidence and characteristics of pancreatic cystic neoplasms. Gastroenterol Hepatol 33:563–568PubMedCrossRefGoogle Scholar
  2. 2.
    Ahmad NA, Lewis JD, Siegelman ES et al (2000) Role of endoscopic ultrasound and magnetic resonance imaging in the preoperative staging of pancreatic adenocarcinoma. Am J Gastroenterol 95:1926–1931PubMedCrossRefGoogle Scholar
  3. 3.
    Beyer-Enke SA, Hocke M, Ignee A et al (2010) Contrast enhanced transabdominal ultrasound in the characterisation of pancreatic lesions with cystic appearance. JOP 11:427–433PubMedGoogle Scholar
  4. 4.
    Brugge WR, Lewandrowski K, Lee-Lewandrowski E et al (2004) Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 126:1330–1336PubMedCrossRefGoogle Scholar
  5. 5.
    Cunningham SC, Hruban RH, Schulick RD (2010) Differentiating intraductal papillary mucinous neoplasms from other pancreatic cystic lesions. World J Gastrointest Surg 2:331–336PubMedCrossRefGoogle Scholar
  6. 6.
    de Jong K, Bruno MJ, Fockens P (2012) Epidemiology, diagnosis, and management of cystic lesions of the pancreas. Gastroenterol Res PractGoogle Scholar
  7. 7.
    de Jong K, Nio CY, Hermans JJ et al (2010) High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 8:806–811CrossRefGoogle Scholar
  8. 8.
    DeWitt J, Devereaux B, Chriswell M et al (2004) Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 141:753–763PubMedGoogle Scholar
  9. 9.
    Dietrich CF, Ignee A, Braden B et al (2008) Improved differentiation of pancreatic tumors using contrast-enhanced endoscopic ultrasound. Clin Gastroenterol Hepatol 6:590–597PubMedCrossRefGoogle Scholar
  10. 10.
    Farrell J, Garber J, Sahani D et al (2004) EUS findings in patients with autoimmune pancreatitis. Gastrointest Endosc 60:927–936PubMedCrossRefGoogle Scholar
  11. 11.
    Fernández-Esparrach G, Ginès A, García P et al (2007) Incidence and clinical significance of hyperamylasemia after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions: a prospective and controlled study. Endoscopy 39:720–724PubMedCrossRefGoogle Scholar
  12. 12.
    Giovannini M, Thomas B, Erwan B et al (2009) Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol 15:1587–1593PubMedCrossRefGoogle Scholar
  13. 13.
    Hammel P, Levy P, Voitot H et al (1995) Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas. Gastroenterology 108:1230–1235PubMedCrossRefGoogle Scholar
  14. 14.
    Hewitt MJ, McPhail MJ, Possamai L et al (2012) EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 75:319–331PubMedCrossRefGoogle Scholar
  15. 15.
    Hocke M, Ignee A, Dietrich CF (2011) Contrast-enhanced endoscopic ultrasound in the diagnosis of autoimmune pancreatitis. Endoscopy 43:163–165PubMedCrossRefGoogle Scholar
  16. 16.
    Hollerbach S, Klamann A, Topalidis T et al (2001) Endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA) cytology for diagnosis of chronic pancreatitis. Endoscopy 33:824–831PubMedCrossRefGoogle Scholar
  17. 17.
    Iglesias-Garcia J, Larino-Noia J, Abdulkader I et al (2010) Quantitative endoscopic ultrasound elastography: an accurate method for the differentiation of solid pancreatic masses. Gastroenterology 139:1172–1180PubMedCrossRefGoogle Scholar
  18. 18.
    Jemaa Y, Houissa F, Trabelsi S et al (2008) Endoscopic ultrasonography versus helical CT in diagnosis and staging of pancreatic cancer. Tunis Med 86:346–349PubMedGoogle Scholar
  19. 19.
    Kersting S, Konopke R, Kersting F et al (2009) Quantitative perfusion analysis of transabdominal contrast-enhanced ultrasonography of pancreatic masses and carcinomas. Gastroenterology 137:1903–1911PubMedCrossRefGoogle Scholar
  20. 20.
    Kitano M, Kudo M, Yamao K et al (2012) Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol 107:303–310PubMedCrossRefGoogle Scholar
  21. 21.
    Klapman JB, Chang KJ, Lee JG et al (2005) Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol 100:2658–2661PubMedCrossRefGoogle Scholar
  22. 22.
    Kucera S, Centeno BA, Springett G (2012) Cyst fluid carcinoembryonic antigen level is not predictive of invasive cancer in patients with intraductal papillary mucinous neoplasm of the pancreas. JOP 13:409–413PubMedGoogle Scholar
  23. 23.
    Liu CL, Fan ST, Lo CM et al (2005) Comparison of early endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the management of acute biliary pancreatitis: a prospective randomized study. Clin Gastroenterol Hepatol 3:1238–1244PubMedCrossRefGoogle Scholar
  24. 24.
    Lowenfels AB, Maisonneuve P, Cavallini G et al (1993) Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 328:1433PubMedCrossRefGoogle Scholar
  25. 25.
    Miller FH, Rini NJ, Keppke AL (2006) MRI of adenocarcinoma of the pancreas. Am J Roentgenol 187:W365–W374CrossRefGoogle Scholar
  26. 26.
    Müller MF, Meyenberger C, Bertschinger P et al (1994) Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging. Radiology 190:745–751PubMedGoogle Scholar
  27. 27.
    Saftoiu A, Vilmann P, Gorunesco F et al (2011) Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy 43:596–603PubMedCrossRefGoogle Scholar
  28. 28.
    Sahai AV, Zimmerman M, Aabakken L et al (1998) Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 48:18–25PubMedCrossRefGoogle Scholar
  29. 29.
    Seicean A, Badea R, Mocan T et al (2008) Radial endoscopic ultrasonography in the preoperative staging of pancreatic cancer. J Gastrointestin Liver Dis 17:273–278PubMedGoogle Scholar
  30. 30.
    Shrikhande SV, Barreto SG, Goel M et al (2012) Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature. HPB 14:658–668PubMedCrossRefGoogle Scholar
  31. 31.
    Tamm EP, Loyer EM, Faria SC et al (2007) Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer. Abdom Imaging 32:660–667PubMedCrossRefGoogle Scholar
  32. 32.
    Tanaka M, Chari S, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32PubMedCrossRefGoogle Scholar
  33. 33.
    Tellez-Avila FI, Chavez-Tapia NC, López-Arce G et al (2012) Vascular invasion in pancreatic cancer: predictive values for endoscopic ultrasound and computed tomography imaging. Pancreas 41:636–638PubMedCrossRefGoogle Scholar
  34. 34.
    Tse F, Liu L, Barkun AN et al (2008) EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc 67:235–244PubMedCrossRefGoogle Scholar
  35. 35.
    Vasile TA, Socaciu M, StanIuga R et al (2012) Added value of intravenous contrast-enhanced ultrasound for characterization of cystic pancreatic masses: a prospective study on 37 patients. Med Ultrason 14:108–114PubMedGoogle Scholar
  36. 36.
    Visser BC, Muthusamy VR, Yeh BM et al (2008) Diagnostic evaluation of cystic pancreatic lesions. HPB 10:63–69PubMedCrossRefGoogle Scholar
  37. 37.
    Wiersema MJ, Hawes RH, Lehman GA et al (1993) Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy 25:555–564PubMedCrossRefGoogle Scholar
  38. 38.
    Williams DB, Sahai AV, Aabakken L et al (1999) Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut 44:720–726PubMedCrossRefGoogle Scholar
  39. 39.
    Zhang XM, Mitchell DG, Dohke M et al (2002) Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 223:547–553PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Medizinische Klinik CKlinikum LudwigshafenLudwigshafenDeutschland

Personalised recommendations