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Endosonography, Contrast Agents, and Elastography

  • Masayuki KitanoEmail author
  • Kosuke Minaga
  • Masatoshi Kudo
Chapter
  • 519 Downloads

Abstract

Recent advances in endoscopic ultrasonography (EUS) imaging technology has led to the evolution of the image-enhanced EUS modalities called contrast-enhanced EUS and EUS elastography. These modalities can depict tissue structure in detail and thus are clinically useful for diagnosing pancreatobiliary and upper gastrointestinal diseases. Moreover, they complement EUS-guided fine-needle aspiration (EUS-FNA) by correctly diagnosing lesions with EUS-FNA false-negative findings and by identifying the most appropriate target site of EUS-FNA. This chapter focuses on the upcoming techniques of imaging in the field of EUS and how these techniques improve the diagnostic ability of EUS, particularly in terms of characterizing conventional EUS-detected lesions.

Keywords

Ultrasound contrast agents Contrast-enhanced endoscopic ultrasound Endoscopic ultrasonography Elastography Elasticity imaging Pancreatobiliary diseases 

Abbreviations

AUC

Area under ROC curve

CP

Chronic pancreatitis

CT

Computed tomography

EUS

Endoscopic ultrasonography

FNA

Fine-needle aspiration

GISTs

Gastrointestinal stromal tumors

NPV

Negative predictive value

PEI

Pancreatic exocrine insufficiency

PPV

Positive predictive value

PSC

Primary sclerosing cholangitis

ROI

Region of interest

SETs

Subepithelial tumors

SR

Strain ratio

TIC

Time–intensity curve

UCAs

Ultrasound contrast agents

Supplementary material

Video 11.1

Endoscopic ultrasonography (EUS) image of a branch-duct type malignant intraductal papillary mucinous neoplasm in the head of the pancreas. EUS reveals a multilocular cystic lesion of 40 mm in diameter. A 15 × 12 mm mural nodule is depicted inside the cystic lesion. After infusion of UCA, contrast-enhanced harmonic EUS image shows that the mural nodule has abundant vascularity (MOV 10298 kb)

Video 11.2

Endoscopic ultrasonography (EUS) image of a gallbladder adenocarcinoma. EUS reveals a 30 × 13 mm low echoic mass lesion in the body of the gallbladder. After infusion of UCA, contrast-enhanced harmonic EUS indicates that the lesion exhibits heterogeneous enhancement with intratumoral irregular vessels (MP4 23389 kb)

Video 11.3

Endoscopic ultrasonography (EUS) image of a liver metastasis of a pancreatic carcinoma. Left image shows conventional EUS image, and right image shows EUS elastography image. EUS elastography depicts a nodule of 6 mm in diameter which shows relatively homogenous hard pattern (predominant blue pattern) in the liver (right). However, conventional EUS cannot identify the nodule (left) (MOV 3274 kb)

Video 11.4

Endoscopic ultrasonography (EUS) image and contrast-enhanced harmonic EUS-guided fine-needle aspiration of a malignant intra-abdominal lymph node. EUS reveals a low echoic lesion of 40 mm in diameter around the aorta. After infusion of UCA, contrast-enhanced harmonic EUS indicates that the lesion exhibits heterogeneous enhancement with avascular area. On real-time imaging with contrast-enhancement EUS, the site with hyperenhancement in the lesion is punctured with a 22-gauge EUS-FNA needle, which revealed a lymph node metastasis of neuroendocrine carcinoma (MP4 21721 kb)

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Masayuki Kitano
    • 1
    Email author
  • Kosuke Minaga
    • 1
  • Masatoshi Kudo
    • 1
  1. 1.Department of Gastroenterology and HepatologyKinki University Faculty of MedicineOsaka-SayamaJapan

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