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EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Recently, the usefulness of endoscopic ultrasound (EUS) elastography has been reported for the diagnosis of pancreatic lesions. In the present study, we retrospectively assessed EUS elastography as a diagnostic tool by evaluating tissue elasticity distribution and elasticity semiquantification, using the strain ratio (SR) of tissue elasticity, in patients with pancreatic masses.

Methods

One hundred and nine patients who underwent EUS elastography between September 2006 and May 2009 were retrospectively evaluated. The final diagnosis was chronic pancreatitis (CP) in 20 patients [6 with non-mass-forming pancreatitis, 7 with mass-forming pancreatitis (MFP), and 7 with autoimmune pancreatitis (AIP)], pancreatic cancer (PC) in 72, pancreatic neuroendocrine tumor (PNET) in 9, and normal pancreas in 8. The tissue elasticity distribution calculation was performed in real time, and the results were represented in color in fundamental B-mode imaging. In addition, we performed quantification using the SR (non-mass area/mass area).

Results

Elastography for all PC patients showed intense blue coloration, indicating malignant lesions. In contrast, MFP presented with a mixed coloration pattern of green, yellow, and low-intensity blue. Normal controls showed an even distribution of green to red. The mean SR was 23.66 ± 12.65 for MFP and 39.08 ± 20.54 for PC (P < 0.05).

Conclusions

Endoscopic ultrasound elastography is a promising diagnostic tool for defining the tissue characteristics of pancreatic masses. In addition, semiquantitative analysis of elasticity using the SR may allow the differentiation of MFP from PC.

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Abbreviations

EUS:

Endoscopic ultrasound

EUS-FNA:

Endoscopic ultrasound fine-needle aspiration

SR:

Strain ratio

CP:

Chronic pancreatitis

MFP:

Mass-forming pancreatitis

AIP:

Autoimmune pancreatitis

PC:

Pancreatic cancer

PNET:

Pancreatic neuroendocrine tumor

References

  1. Giovannini M, Hookey LC, Bories E, Pesenti C, Monges G, Delpero JR. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients. Endoscopy. 2006;38:344–8.

    Article  PubMed  CAS  Google Scholar 

  2. Săftoiu A, Vilman P. Endoscopic ultrasound elastography: a new imaging technique for the visualization of tissue elasticity distribution. J Gastrointestin Liver Dis. 2006;15:161–5.

    PubMed  Google Scholar 

  3. Janssen J, Schlörer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc. 2007;65:971–8.

    Article  PubMed  Google Scholar 

  4. Săftoiu A, Vilmann P, Ciurea T, Popescu GL, Iordache A, Hassan H, et al. Dynamic analysis of EUS used for the differentiation of benign and malignant lymph nodes. Gastrointest Endosc. 2007;66:291–300.

    Article  PubMed  Google Scholar 

  5. Săftoiu A, Vilmann P, Gorunescu F, Gheonea DI, Gorunescu M, Ciurea T, et al. Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer. Gastrointest Endosc. 2008;68:1086–94.

    Article  PubMed  Google Scholar 

  6. Giovannini M, Thomas B, Erwan B, Christian P, Fabrice C, Benhamin E, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol. 2009;15:1587–93.

    Article  PubMed  Google Scholar 

  7. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, Forteza J, Dominguez-Munoz JE. EUS elastography for the characterization of solid pancreatic masses. Gastrointest Endosc. 2009;70:1101–8.

    Article  PubMed  Google Scholar 

  8. Waki K, Murayama N, Matsumura T, et al. Investigation of strain ratio using ultrasound elastography technique. Proc ISICE. 2007;2007:449–52.

    Google Scholar 

  9. Okazaki K, Kawa S, Kamisawa T, Naruse S, Tanaka S, Nishimori I, et al. Clinical diagnosis criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006;41:626–31.

    Article  PubMed  Google Scholar 

  10. Wiersema MJ, Hawes RH, Lehman GA, Kochman ML, Sherman S, Kopecky KK. Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy. 1993;25:555–64.

    Article  PubMed  CAS  Google Scholar 

  11. Catalano MF, Lahoti S, Geenen JE, Hogan WJ. Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in diagnosis of chronic pancreatitis. Gastrointest Endosc. 1998;48:11–7.

    Article  PubMed  CAS  Google Scholar 

  12. 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.

    PubMed  CAS  Google Scholar 

  13. Brand B, Pfaff T, Binmoellor KF, Sriam PV, Fritscher-Racens A, Knofel WT, et al. Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery. Scand J Gastroenterol. 2000;36:1221–8.

    Google Scholar 

  14. Varadajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc. 2005;62:728–36.

    Article  Google Scholar 

  15. Eloubeidi MA, Tamhane A, Varadarajulu S, Wilcox CM. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc. 2006;63:622–9.

    Article  PubMed  Google Scholar 

  16. Eloubeidi MA, Chen VK, Eltoum IA, Jhala D, Chhieng DC, Jhala N. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol. 2003;98:2663–8.

    PubMed  Google Scholar 

  17. Raut CP, Grau AM, Staerkel GA, Kaw M, Tamm EP, Wolff RA, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg. 2003;7:118–28.

    Article  PubMed  Google Scholar 

  18. Agarwal B, Abu-Hamda E, Molke KL, Correa AM, Ho L. Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol. 2004;100:844–50.

    Article  Google Scholar 

  19. Fritscher-Racens A, Brand L, Knofel T, Bobrowski C, Topalidis T, Thonke F, et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol. 2002;97:2768–75.

    Article  Google Scholar 

  20. Fritscher-Ravens A. Blue clouds and green clouds: virtual biopsy via EUS elastography. Endoscopy. 2006;38:416–7.

    Article  PubMed  CAS  Google Scholar 

  21. Gill KR, Wallace MB. EUS elastography for pancreatic mass lesions: between image and FNA? Gastrointest Endosc. 2008;68:1095–7.

    Article  PubMed  Google Scholar 

  22. Jacobson BC. Pressed for an answer: has elastography finally come to EUS? Gastrointest Endosc. 2007;66:301–3.

    Article  PubMed  Google Scholar 

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Acknowledgments

We are grateful to Mr. Roderick J. Turner and Professor J. Patrick Barron of the Department of International Medical Communications of Tokyo Medical University for their review of the manuscript. We are grateful to Dr. Marc Giovannini of the Paoli-Calmettes Institute for his valuable technical and editing suggestions.

Conflict of interest

The following authors disclose financial relationships relevant to this publication: Fumihide Itokawa and Takao Itoi: speaker and consultant for Pentax Co. Ltd. The other authors disclose no financial relationship relevant to this publication.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Fumihide Itokawa, Takao Itoi, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Junko Umeda, Reina Tanaka & Fuminori Moriyasu

  2. Department of Clinical Oncology, Tokyo Medical University, Tokyo, Japan

    Naoyuki Yokoyama

  3. Third Department of Surgery, Tokyo Medical University, Tokyo, Japan

    Kazuhiko Kasuya & Akihiko Tsuchida

  4. Department of Pathology, Tokyo Medical University, Tokyo, Japan

    Toshitaka Nagao

  5. Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Terumi Kamisawa

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  1. Fumihide Itokawa
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  2. Takao Itoi
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Corresponding author

Correspondence to Takao Itoi.

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Itokawa, F., Itoi, T., Sofuni, A. et al. EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses. J Gastroenterol 46, 843–853 (2011). https://doi.org/10.1007/s00535-011-0399-5

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  • DOI: https://doi.org/10.1007/s00535-011-0399-5

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