The application value of contrast-enhanced ultrasound in the differential diagnosis of pancreatic solid-cystic lesions

doi:10.1016/j.ejrad.2011.03.048

European Journal of Radiology

Volume 81, Issue 7, July 2012, Pages 1432-1437

https://doi.org/10.1016/j.ejrad.2011.03.048 Get rights and content

Abstract

Objective

To retrospectively determine the accuracy of baseline ultrasound (BUS) and of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of pancreatic solid-cystic lesions.

Methods

Fifty-four pancreatic solid-cystic lesions in 52 patients were examined with BUS and CEUS, two different seniority radiologists read the images independently, Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic value of BUS and CEUS in the diagnosis of benign or malignant pancreatic solid-cystic lesions, the diagnostic consistency between different seniority radiologists was evaluated by Kappa statistics.

Results

Among the 54 lesions, there were pancreatic cyst five cases, pancreatic pseudocyst twenty cases, pancreatic cystadenoma eight cases, pancreatic cystadenocarcinoma seven cases, intraductal papillary mucinous neoplasm of pancreas (IPMN) three cases, pancreatic carcinoma combined liquefied six cases, solid-pseudopallary tumor of pancreas (SPTP) three cases, pancreatic myopericytoma one case, pancreatic lymphangioma one case. After ROC analysis, the areas under the ROC curve (Az) were 0.752 by BUS, 0.928 by CEUS to resident radiologist, and 0.896 by BUS, 0.954 by CEUS to staff radiologist. The correct diagnosis rate of specific disease was 42.6% by BUS, 64.8% by CEUS to staff radiologist (P < 0.05), and 33.3% by BUS, 53.7% by CEUS to resident radiologist (P < 0.05). The interobserver agreement in CEUS is higher than that in BUS, the Kappa value was 0.889 ± 0.062 and 0.428 ± 0.126 respectively.

Conclusion

Compared with BUS, CEUS can significantly enhance the diagnostic rate of pancreatic solid-cystic lesions.

Introduction

Pancreatic solid-cystic lesions are those pancreatic focal lesions which have solid-cystic nature, variable histologic characteristics and biologic behavior [1], [2]. With the advancement of imaging technology and improvement of population health care, asymptomatic pancreatic solid-cystic lesions are increasingly being detected. The pancreatic solid-cystic lesions can be divided into benign or malignant lesions, which have different treatment methods. The malignant ones need to do operation, but the benign ones need not. Therefore, it is important to distinguish malignant lesions from benign ones. Baseline ultrasound (BUS) examination is the first imaging method used in the judgement of pancreatic solid-cystic lesions. But it only provides limited information and has low ability to differentiate different lesions. Contrast-enhanced ultrasound (CEUS) is a procedure with a high sensitivity and specificity in the differentiation of liver and pancreatic tumors [3], [4]. To date, little studies have used these procedures in an attempt to differentiate different pancreatic solid-cystic lesions. The aim of the study is to evaluate the diagnostic performance of CEUS for pancreatic solid-cystic lesions.

Section snippets

Patients

From March 2006 to 2011, we retrospectively studied 54 lesions of 52 patients with pancreatic solid-cystic lesions who had undergone BUS and CEUS in our institution. The inclusion criteria were: confirmed by pathology; confirmed by surgery or analyzing the cyst fluid through interventional ultrasound for pancreatic pseudocysts; reduced or no change in lesions following up longer than one year for pancreatic cysts or pseudocysts. Twenty-nine patients presented with clinical symptoms (jaundice,

Conventional ultrasound performance

There were pancreatic cyst five cases, pancreatic pseudocyst 20 cases, pancreatic cystadenoma eight cases, pancreatic cystadenocarcinoma seven cases, intraductal papillary mucinous neoplasm of pancreas (IPMN) three cases, pancreatic carcinoma combined liquefied six cases, solid-pseudopallary tumor of pancreas (SPTP) three cases, pancreatic myopericytoma one case, pancreatic lymphangioma one case. Table 2 presents the performance of conventional ultrasound for pancreatic solid-cystic lesions.

CEUS performance

Discussion

Pancreatic cystic tumors account for 10–15% of solid-cystic lesions of the pancreas and have variable histologic characteristics, malignant potential and biologic behavior [2], [7]. Mucinous pancreatic cystadenoma and IPMN are considered precancerous lesions. So initial imaging studies are critical to getting definitive and reliable differentiation between benign and malignant lesions [8]. Although BUS has been regarded as the first-line modality for pancreatic solid-cystic lesions, its

Conclusions

CEUS can improve the capability of discrimination benign pancreatic solid-cystic lesions from malignant ones, especially for resident radiologists.

Conflict of interest

None declared.

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A total of 113 patients were randomly split into the training (n = 79) and test cohorts (n = 34). These patients were pathologically diagnosed with SCA, mucinous cystadenoma, intraductal papillary mucinous neoplasm and solid-pseudopapillary tumor. The radiomics model achieved an AUC of 0.875 and 0.862 in the training and test cohorts, respectively. The sensitivity and specificity of the radiomics model were 81.5% and 86.5% in the training cohort and 81.8% and 91.3% in the test cohort, respectively, which were higher than or comparable with that of the CEUS model and the combined model.
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Citation Excerpt :
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To evaluate the diagnostic performance of contrast-enhanced ultrasound for benign and malignant pancreatic neoplasms.
Pubmed, Embase, Web of Science, and Cochrane Library databases.
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Patients with a confirmed diagnosis of benign and malignant pancreatic neoplasms.
Contrast-enhanced ultrasound.
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CRD42017070434 (PROSPERO).
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The application value of contrast-enhanced ultrasound in the differential diagnosis of pancreatic solid-cystic lesions

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Patients

Conventional ultrasound performance

CEUS performance

Discussion

Conclusions

Conflict of interest

Pancreatology

Cystic tumors of the pancreas: evaluation by ultrasonography and computed tomography

Gastrointest Radiol

Cystic tumors of the pancreas

Surg Clin North Am

Contrast-enhanced sonography in the diagnosis of small hepatocellular carcinoma ≤2 cm

J Clin Ultrasound

Echo-enhanced ultrasound with pulse inversion imaging: a new imaging modality for the differentiation of cystic pancreatic tumours

World J Gastroenterol

Differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography

Scand J Gastroenterol