Skip to main content

Advertisement

SpringerLink
Log in

Echo-enhanced ultrasound—a new imaging modality for the differentiation of pancreatic lesions

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Echo-enhanced ultrasound is a newly available mode of imaging for differential diagnosis of pancreatic tumours. Ductal carcinomas are often hypovascularised compared with the surrounding tissue. Neuroendocrine tumours, on the other hand, are hypervascularised lesions. Tumours associated with pancreatitis have a different vascularisation pattern depending on inflammation and necrosis. Cystadenomas frequently have many vessels along the fibrotic strands.

Results

Data from prospective studies have demonstrated, on the basis of these imaging criteria, that the sensitivity and specificity of echo-enhanced sonography for differentiation of pancreatic masses are ≥85 and ≥90%, respectively.

Conclusions

Pancreatic tumours have a different vascularisation pattern in echo-enhanced ultrasound. These characteristics can be used with high diagnostic accuracy for differential diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Hartmann D, Schilling D, Bassler B, Adamek HE, Layer G, Riemann JF (2004) ERCP and MRCP in the differentiation of pancreatic tumors. Dig Dis 22:18–25

    Article  PubMed  Google Scholar 

  2. Sugiyama M, Atomi Y, Hachiya J (1998) Intraductal papillary tumours of the pancreas. Evaluation with magnetic resonance cholangiopancreatography. Am J Gastroenterol 93:156–159

    Article  CAS  PubMed  Google Scholar 

  3. Hintze RE, Adler A, Veltzke H et al (1997) Clinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 29:182–187

    CAS  PubMed  Google Scholar 

  4. Adamek HE, Weitz M, Breer H, Jakobs R, Schilling D, Riemann JF (1997) Value of magnetic-resonance cholangiopancreatography (MRCP) after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 29:741–744

    CAS  PubMed  Google Scholar 

  5. Soto JA, Barish MA, Yucel EK, Siegenberg D, Ferrucci JT, Chuttani R (1996) Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography. Gastroenterology 110:589–597

    CAS  PubMed  Google Scholar 

  6. Karlson BM, Ekbom A, Lindgren PG et al (1999) Abdominal US for diagnosis of pancreatic tumour: prospective cohort analysis. Radiology 213:107–111

    CAS  PubMed  Google Scholar 

  7. Palazzo L, Roseau G, Gayet B et al (1993) Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Endoscopy 25:143–150

    CAS  PubMed  Google Scholar 

  8. Rösch T, Lorenz R, Braig C, Feuerbach S, Siewert JR, Classen M (1990) Endoscopic ultrasound in the diagnosis of pancreatic tumours. Dtsch Med Wochenschr 115:1339–1347

    PubMed  Google Scholar 

  9. Rickes S, Unkrodt K, Ocran K et al (2000) Evaluation of Doppler ultrasonography criteria for the differentiation of pancreatic tumours. Ultraschall Med 20:253–258

    Article  Google Scholar 

  10. Wermke W, Gaßmann B (1998) Tumour diagnostics of the liver with echo enhancers. Springer Verlag, Berlin Heidelberg New York

    Google Scholar 

  11. Tanaka S, Kitamra T, Fujita M, Yoshioka F (1998) Value of contrast-enhanced color Doppler sonography in diagnosing hepatocellular carcinoma with special attention to the “color-filled pattern”. J Clin Ultrasound 26:207–212

    Article  CAS  PubMed  Google Scholar 

  12. Rickes S, Ocran K, Schulze S, Wermke W (2002) Evaluation of Doppler sonographic criteria for the differentiation of hepatocellular carcinomas and regenerative nodules in patients with liver cirrhosis. Ultraschall Med 23:83–90

    Article  CAS  PubMed  Google Scholar 

  13. Rickes S, Schulze S, Neye H, Ocran KW, Wermke W (2003) Improved diagnosing of small hepatocellular carcinomas by echo-enhanced power Doppler sonography in patients with cirrhosis. Eur J Gastroenterol Hepatol 15:893–900

    Article  PubMed  Google Scholar 

  14. Strobel D, Hoefer A, Martus P, Hahn EG, Becker D (2001) Dynamic contrast-enhanced power Doppler sonography improves the differential diagnosis of liver lesions. Int J Colorectal Dis 16:247–256

    Article  CAS  PubMed  Google Scholar 

  15. Rickes S, Ocran KW, Gerstenhauer G, Wermke W (2004) Evaluation of diagnostic criteria for liver metastases of adenocarcinomas and neuroendocrine tumours at conventional ultrasound, unenhanced power Doppler sonography and echo-enhanced ultrasound. Dig Dis 22:81–86

    Article  PubMed  Google Scholar 

  16. Rickes S, Flath B, Unkrodt K et al (2001) Pancreatic metastases of renal cell carcinomas—evaluation of the contrast behaviour at echo-enhanced power Doppler sonography in comparison to primary pancreatic tumours. Z Gastroenterol 39:571–578

    Article  CAS  PubMed  Google Scholar 

  17. Rickes S, Unkrodt K, Neye H, Ocran KW, Wermke W (2002) Differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography. Scand J Gastroenterol 37:1313–1320

    Article  CAS  PubMed  Google Scholar 

  18. Rickes S, Unkrodt K, Ocran K, Neye H, Wermke W (2003) Differentiation of neuroendocrine tumours from other pancreatic lesions by echo-enhanced power Doppler sonography and somatostatin receptor scintigraphy. Pancreas 26:76–81

    Article  CAS  PubMed  Google Scholar 

  19. Ding H, Kudo M, Onda H, Nomura H, Haji S (2001) Sonographic diagnosis of pancreatic islet cell tumor: value of intermittent harmonic imaging. J Clin Ultrasound 29:411–416

    Article  CAS  PubMed  Google Scholar 

  20. Rickes S, Wermke W (2004) Differentiation of cystic pancreatic neoplasms and pseudocysts by conventional and echo-enhanced ultrasound. J Gastroenterol Hepatol 19:761–766

    Article  PubMed  Google Scholar 

  21. Loperfido A, Angelini G, Benedetti G et al (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48:1–10

    CAS  PubMed  Google Scholar 

  22. Bilbao MK, Dotter CT, Lee TG, Katon RM (1976) Complications of endoscopic retrograde cholangiopancreatography (ERCP). Gastroenterology 70:314–320

    CAS  PubMed  Google Scholar 

  23. Becker D, Strobel D, Bernatik T, Hahn EG (2001) Echo-enhanced color- and power-Doppler EUS for the discrimination between focal pancreatitis and pancreatic carcinoma. Gastrointest Endosc 53:784–789

    Article  CAS  PubMed  Google Scholar 

  24. Hocke M, Gottschalk P, Dietrich CF (2004) Ultraschall Med 25(S1): Abstract WS_23_02

  25. Schima W, Fugger R, Schober E et al (2002) Diagnosis and staging of pancreatic cancer: comparison of mangafodipir trisodium-enhanced MR imaging and contrast-enhanced helical hydro-CT. Am J Radiol 179:717–724

    Google Scholar 

  26. Papos M, Takacs T, Tron L et al (2002) The possible role of F-18 FDG positron emission tomography in the differential diagnosis of focal pancreatic lesions. Clin Nucl Med 27:197–201

    Article  PubMed  Google Scholar 

  27. Diehl SJ, Lehmann KJ, Sadick M, Lachmann R, Georgi M (1998) Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 206:373–378

    CAS  PubMed  Google Scholar 

  28. Legman P, Vignans O, Dousser B et al (1998) Pancreatic tumours; comparison of dual-phase helical CT and endoscopic sonography. Am J Radiol 170:1315–1322

    Google Scholar 

  29. Rösch T, Braig C, Gain T et al (1992) Staging of pancreatic and ampullary carcinoma by endoscopic ultrasound. Gastroenterology 102:188–199

    PubMed  Google Scholar 

  30. Goldstein HM, Neiman HL, Bookstein JJ (1974) Angiography evaluation of pancreatic disease. A further appraisal. Radiology 112:275–282

    CAS  PubMed  Google Scholar 

  31. Reuter SR, Redman HC, Bookstein JJ (1970) Differential diagnosis of carcinoma of the pancreas. Radiology 96:93–99

    CAS  PubMed  Google Scholar 

  32. Appleton GV, Bathurst NC, Virjee J, Cooper MJ, Williamson RC (1989) The value of angiography in the surgical management of pancreatic disease. Ann R Coll Surg Engl 71:92–96

    CAS  PubMed  Google Scholar 

  33. Koito K, Namieno T, Morita K (1998) Differential diagnosis of small hepatocellular carcinoma and adenomatous hyperplasia with power Doppler sonography. Am J Radiol 170:157–161

    CAS  Google Scholar 

  34. Calliada F, Campani R, Bottinelli O, Bozzini A, Sommaruga MG (1998) Ultrasound contrast agents. Basic principles. Eur J Radiol 27:157–160

    Article  Google Scholar 

  35. Correas JM, Hélénon O, Pourcelot L, Moreau JF (1997) Ultrasound contrast agents. Examples of blood pool agents. Acta Radiol 38:101–112

    Google Scholar 

  36. Kim AY, Choi BI, Kim TK, Kim KW, Lee JY, Han JK (2001) Comparison of contrast-enhanced fundamental imaging, second-harmonic imaging, and pulse-inversion harmonic imaging. Invest Radiol 36:582–588

    Article  CAS  PubMed  Google Scholar 

  37. Rösch T, Lightdale CJ, Botet JF et al (1992) Localisation of pancreatic endocrine tumours by endoscopic ultrasonography. N Engl J Med 326:1721–1726

    PubMed  Google Scholar 

  38. Hirota T, Tomida T, Iwasa M, Takahashi K, Kaneda M, Tamaki H (1996) Solitary pancreatic metastasis occurring eight years after nephrectomy for renal cell carcinoma: a case report and review of the literature. Int J Pancreatol 19:145–153

    CAS  PubMed  Google Scholar 

  39. Thompson LDR, Heffess CS (2000) Renal cell carcinoma to the pancreas in surgical pathology material. A clinicopathological study of 21 cases with a review of the literature. Cancer 89:1076–1088

    Google Scholar 

  40. Rickes S, Unkrodt K, Neye H, Ocran K, Lochs H, Wermke W (2002) Differential diagnosis of frequent pancreatic tumours with echo-enhanced power-Doppler sonography—presentation of case reports. Z Gastroenterol 40:235–240

    Article  CAS  PubMed  Google Scholar 

  41. Ueno E, Takada Y, Yoshida I, Toda J, Sugiura T, Toki F (1998) Pancreatic diseases: evaluation with MR cholangiopancreatography. Pancreas 16:418–426

    CAS  PubMed  Google Scholar 

  42. Koito K, Namieno T, Ichimura T et al (1998) Mucin-producing tumour of the pancreas: comparison of MR cholangiopancreatography with ER cholangiopancreatography. Radiology 208:231–237

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Infectiology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Steffen Rickes & Peter Malfertheiner

Authors
  1. Steffen Rickes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Malfertheiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steffen Rickes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rickes, S., Malfertheiner, P. Echo-enhanced ultrasound—a new imaging modality for the differentiation of pancreatic lesions. Int J Colorectal Dis 21, 269–275 (2006). https://doi.org/10.1007/s00384-004-0725-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-004-0725-y

Keywords

Search

Navigation