ABSTRACT
PURPOSE: Contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) for the assessment of microcirculation and the delineation of pancreatic tumors in order to characterize and stage them has only recently become available for commercial use, and few reports have been published. The purpose of the study was the qualitative and quantitative digital image analysis of pancreatic adenocarcinomas using conventional endoscopic ultrasonography (EUS) and CEH-EUS and the evaluation of whether contrast medium injection modified adenocarcinoma staging and patient management. MATERIALS AND METHODS: In each of 30 prospectively examined patients with suspected pancreatic solid lesions, CEH-EUS was performed using the same quantity of the contrast agent SonoVue and a low mechanical index (0.3 - 0.4), followed by EUS-FNA. The histology, based on EUS-FNA or surgery and 9 months of follow-up, was: pancreatic adenocarcinoma (n = 15), pseudotumoral chronic pancreatitis (n = 12), neuroendocrine tumor (n = 1), common bile duct tumor (n = 1), lymph node metastases of gastric cancer (n = 1). The quantitative analysis was based on histograms obtained from each CEH-EUS video recording. RESULTS: CEH-EUS showed a hypoenhanced pattern in 14 cases of adenocarcinoma and in 10 cases of chronic pancreatitis. The index of the contrast uptake ratio was significantly lower in adenocarcinoma than in mass-forming chronic pancreatitis. A cut-off uptake ratio index value of 0.17 for diagnosing adenocarcinoma corresponded to an AUC (CI 95%) of 0.86 (0.67 - 1.00) with a sensitivity of 80%, a specificity of 91.7%, a positive predictive value of 92.8%, and a negative predictive value of 78%. The size of the pancreatic mass was assessed significantly more effectively by CEH-EUS but adenocarcinoma staging was not modified. CONCLUSION: The majority of cases of both pancreatic adenocarcinoma and chronic pancreatitis were hypoenhanced and visual discrimination was not possible. This is the first study about CEH-EUS for the quantitative assessment of uptake after contrast injection which has shown that it can aid differentiation between benign and malignant masses but cannot replace EUS-FNA. Neither tumor stage nor therapeutic management have changed after contrast medium injection during CEH-EUS.
Subject(s)
Adenocarcinoma/diagnostic imaging , Endosonography/methods , Image Enhancement/methods , Image Processing, Computer-Assisted/methods , Pancreatic Neoplasms/diagnostic imaging , Tumor Burden/physiology , Adenocarcinoma/blood supply , Adenocarcinoma/pathology , Aged , Aged, 80 and over , Biopsy , Contrast Media/administration & dosage , Diagnosis, Differential , Female , Humans , Male , Microvessels/diagnostic imaging , Middle Aged , Neoplasm Staging , Neovascularization, Pathologic/diagnostic imaging , Pancreatic Neoplasms/blood supply , Pancreatic Neoplasms/pathology , Pancreatitis, Chronic/diagnostic imaging , Pancreatitis, Chronic/pathology , Phospholipids , Prospective Studies , Sulfur HexafluorideABSTRACT
AIM: The value of conventional radiology, electrocardiography and echocardiography in estimating the prevalence of left ventricular (LV) remodeling patterns in patients with newly discovered hypertension was less studied. The aim of the present study was to assess the accuracy of conventional radiology and electrocardiography compared to echocardiography in the diagnosis of left ventricular hypertrophy (LVH) and different remodeling types in male patients with recent primary arterial hypertension (PAH). METHODS: This cross-sectional study, enrolled 420 male patients with recent stage 2 PAH, diagnosed less than a year before, and 420 normotensive male subjects, using conventional radiological methods, ECG and also echocardiography. The ultrasound examination documented four types of LV remodeling, based on the measurement of LV parameters: concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling (CR) and the normal variant (NV). RESULTS: In the recent PAH group, echocardiography diagnosed LV patterns in different proportions (34.285% CR; 24.285% NV; 21.43% EH; 20% CH), whereas the standard radiological examination and ECG documented LVH positive criteria in a much lower proportion of cases, for these patterns. CONCLUSION: The ECG and radiological examinations detected LVH in patients with EH, and CH, but both examinations were inconclusive in those with CR and NV. This study comparatively reflects the effectiveness of echocardiography, electrocardiography and conventional radiology, in the diagnosis of LV patterns in newly discovered hypertension and also illustrates the arguments for and against the usage of these three imagery techniques.