Endoscopy 2016; 48(01): 26-34
DOI: 10.1055/s-0034-1393563
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Contrast-enhanced harmonic endoscopic ultrasonography with time–intensity curve analysis for intraductal papillary mucinous neoplasms of the pancreas

Naoki Yamamoto
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Hironari Kato
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Takeshi Tomoda
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Kazuyuki Matsumoto
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Ichiro Sakakihara
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Yasuhiro Noma
2   Department of Endoscopy, Okayama University Hospital, Okayama, Japan
,
Shigeru Horiguchi
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Ryo Harada
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Koichiro Tsutsumi
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Keisuke Hori
2   Department of Endoscopy, Okayama University Hospital, Okayama, Japan
,
Takehiro Tanaka
3   Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Hiroyuki Okada
2   Department of Endoscopy, Okayama University Hospital, Okayama, Japan
,
Kazuh de Yamamoto
1   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
› Author Affiliations
Further Information

Publication History

submitted: 07 October 2014

accepted after revision: 13 July 2015

Publication Date:
12 November 2015 (online)

Background and study aims: Preoperative diagnosis of the pathological grade of intraductal papillary mucinous neoplasms (IPMNs) is difficult. This study aimed to evaluate the accuracy of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) with time – intensity curve analysis in differentiating between low or intermediate grade dysplasia (LGD/IGD) and high grade dysplasia or invasive carcinoma (HGD/invasive carcinoma) in IPMNs and to assess correlation between the time – intensity curve parameters and tumor microvessel density.

Patients and methods: Data from 30 patients with resected IPMNs (14 LGD/IGD, 16 HGD/invasive carcinoma) who underwent CH-EUS with time – intensity curve analysis were evaluated retrospectively. Time – intensity curve parameters and the microvessel density of the mural nodule were compared between the HGD/invasive carcinoma and LGD/IGD groups; the diagnostic accuracy of the time – intensity curve parameters was evaluated.

Results: The echo intensity change and echo intensity reduction rate of the mural nodule, and the nodule/pancreatic parenchyma contrast ratio were significantly higher in the HGD/invasive carcinoma group than in the LGD/IGD group (P < 0.05); the accuracies of these parameters were 80 %, 86.7 %, and 93.3 %, respectively. The microvessel density of the mural nodule was significantly higher in the HGD/invasive carcinoma group (P = 0.002). There was a strong positive, linear correlation between the echo intensity change of the mural nodule and the microvessel density (r = 0.803, P < 0.001).

Conclusions: CH-EUS with time – intensity curve analysis is potentially useful for quantitatively evaluating the blood flow of IPMN microvasculature, and for differentiating between HGD/invasive carcinoma and LGD/IGD.

Fig. e5, e7, e8

 
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