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• W2020339918 abstract "Background: EUS-FNA has limitations in cancer diagnosis and staging. Mucin-filled (mediastinal) cysts can mimic solid lesions. Improvements in contrast agents, transducers and processors have enhanced the potential of CEH-EUS. Aim: To determine optimal settings and accuracy of CEH-EUS using Definity® (Lantheus Medical Imaging, Inc), a prototype linear echoendoscope (XGF-UC180, Olympus) and Aloka ProSound Alpha10 processor, in a pilot. Methods: Patients with esophageal/pancreatic/liver tumors, or adenopathy, without contraindication to EUS or Definity®, were recruited. EKG monitoring was used. Definity®, a 2nd-generation perflutren lipid microsphere contrast agent, FDA-approved for cardiac imaging, was given (10 uL/kg IV in 1-2 doses) after agitation. Mechanical index (MI) was optimized over 5 cases. Intermittent (1-sec) and continuous imaging was used with extended pure harmonic detection. Perfusion factors were noted (sequence, pattern, washout). Video sequences were recorded (arterial, venous and post-venous phases). Patients without positive tissue were followed for 6 months. Pre-/post-contrast predictions of neoplasia were recorded (5-point Likert scale). Results: An MI of 0.3 appeared optimal: non-linear oscillations without significant disruption, allowing parenchymal (liver/pancreas) perfusion imaging. CEH-EUS took <5 min/site. Thirty sites were imaged in 21 patients (48% male), including 7 nodes and 23 masses (16 pancreatic, 3 hepatic, 2 mediastinal, 1 adrenal and 1 submucosal); 21 sites underwent FNA and 5 were excised in follow-up. CEH-EUS showed a (very) likely benign lesion (diffuse enhancement) in 12, (very) likely neoplastic lesion (perfusion defects) in 18, and 1 indeterminate node. No EUS-benign sites were CEH-EUS-neoplastic; 1 EUS-neoplastic site was CEH-EUS-benign (final diagnosis: likely benign). 4 were EUS-undecided (2 with nonspecific on-site cytology): CEH-EUS appeared correct in 3 and incorrect in 1. Positive and negative predictive values for CEH-EUS were 86.7% and 87.5%. CEH-EUS appeared to significantly change management in at least 2 cases: 1) possible hyperechoic liver metastasis (pancreatic cancer case) not seen on prior imaging demonstrating typical centripetal filling and peripheral nodular pattern of a hemangioma, avoiding FNA; 2) EUS-indeterminate (cyst vs. mass), but CEH-EUS-neoplastic, mediastinal lesion surgically confirmed to be neoplastic. No device-/agent-related adverse events occurred. Conclusions: CEH-EUS achieves excellent imaging with minimal added procedure time. It is accurate, distinguishes mucoid cysts and vascular lesions from solid lesions and changes management significantly in selected cases." @default.
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• W2020339918 date "2009-04-01" @default.
• W2020339918 modified "2023-09-27" @default.
• W2020339918 title "Accuracy of Contrast-Enhanced Harmonic Endoscopic Ultrasound (CEH-EUS) Using Definity®" @default.
• W2020339918 doi "https://doi.org/10.1016/j.gie.2009.03.930" @default.
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