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• W2914372458 abstract "Introduction: The evaluation of pancreatic cysts, masses, and inflammation can be challenging. While endoscopic ultrasound (EUS) has markedly improved our ability to study and sample the pancreas, it yields indeterminate results in >10% of cases. In this tandem controlled study we aim to determine whether quantitative contrast enhancement using perflutren microbubbles improves yield of EUS. Methods: Patients with unexplained pancreatitis, pancreas mass, and cysts (>1cm) were enrolled. During the initial non-enhanced endoscopic ultrasound, a clinical research coordinator recorded the endoscopist's impression according to predefined categories (Table 1). Subsequently, two 0.3cc boluses of agitated perflutren lipid microspheres were injected intravenously. The EUS was then repeated and the endoscopist's impression was again recorded. The accuracy of diagnosis pre- and post-contrast was assessed based on final cytology, surgical pathology, or long-term (>6 month) clinical follow-up. Total procedure duration and immediate complications were also recorded. Post-contrast quantitative analyses of a 7mm2 representative region of the lesion of interest and adjacent normal pancreas were performed. Integration of time-intensity curves was used to calculate the absolute (decibel-dB) and relative intensity of the pancreas lesions (Figure 1).Figure: Time-Intensity Curve (1A) in decibels by regions of interest (1B): parenchyma (magenta), cyst (yellow), enhancing nodule (cyan). FNA-guided biopsy (1C) was performed which showed adenocarcinoma on pathology (1D).Table: Table. Impact of Contrast Enhancement on Diagnostic ImpressionResults: Twenty-five patients with various pancreas lesions were evaluated. Their average age was 60(+17.6) years, 13(52%) were male, and 16(64%) were Hispanic. Contrast enhancement improved the accuracy, 88% (22/25) versus 56% (14/25) of diagnostic EUS (p=0.025). The impact was greatest in assessing pancreas masses and chronic pancreatitis. The mean procedure time was 34.0(±12.4) minutes and there were no complications. The diagnostic confidence improved with the use of contrast. In comparison to normal parenchyma (1.0), the relative intensities of neuroendocrine lesions (1.69 [SE 0.43]) and the septa of serous cystadenomas (1.44 [SE 0.60]) were increased while the relative intensities of carcinoma (0.44 [SE 0.12]) and cyst lumen (0.23 [SE 0.03]) were decreased. The relative intensity of chronic pancreatitis (0.54 [SE 0.06]) was greater than pancreas cancer but less than normal tissue.Table: Relative Intensities of Contrast Enhanced Pancreas LesionsConclusion: Contrast EUS is a promising non-invasive method to evaluate pancreatitis, pancreas cyst, and cancer. It improves diagnostic impression and through quantitative approaches may eventually provide a more objective way to categorize these lesions." @default.
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• W2914372458 date "2017-10-01" @default.
• W2914372458 modified "2023-09-25" @default.
• W2914372458 title "Prospective Tandem Study of Quantitative Contrast Endoscopic Ultrasound of the Pancreas" @default.
• W2914372458 doi "https://doi.org/10.14309/00000434-201710001-00867" @default.
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