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. 2014 Apr;3(2):123-30.
doi: 10.4103/2303-9027.131040.

Pancreatic cystic lesions: The value of contrast-enhanced endoscopic ultrasound to influence the clinical pathway

Michael Hocke  1 , Xin-Wu Cui  2 , Dirk Domagk  3 , Andre Ignee  2 , Christoph F Dietrich  2
Affiliations

Pancreatic cystic lesions: The value of contrast-enhanced endoscopic ultrasound to influence the clinical pathway

Michael Hocke et al. Endosc Ultrasound. 2014 Apr.

Abstract

Background and objectives: Cystic pancreatic lesions are a growing diagnostic challenge. The aim of this study was to proof a new diagnostic concept based on contrast-enhanced endoscopic ultrasound (CE-EUS) for differential diagnosis.

Patients and methods: A total of 125 patients with unclear cystic pancreatic lesions were included. The initial diagnostic was made by CE-EUS dividing the lesions in a group without contrast enhancing effect in the cystic wall, septae or nodule indicating pseudocysts or dysontogenetic cysts and a group with contrast enhancing effect in the described structures indicating cystic neoplasias. The investigations were performed using a Pentax echoendoscope and Hitachi Preirus ultrasound machine. The contrast enhancer used was 4.8 mL SonoVue(®) (Bracco, Italy). The group with suspected cystic neoplasia was referred for endoscopic fine-needle puncture for further diagnostic or treatment decisions.

Results: The dividing of the groups by contrast-enhanced ultrasound was feasible because all (n = 56) suspected cystic neoplasias showed a contrast enhancing effect, whereas in only 4 from 69 pseudocystic or dysontogenetic cystic lesions a contrast enhancing effect in the wall could be observed. Endoscopic fine-needle puncture could diagnose all malignant neoplasias and relevant premalignant conditions. The long-term follow-up did not show any development of malignant cystic lesions.

Conclusion: Using CE-EUS and endoscopic fine-needle puncture as diagnostic criteria seemed to be a feasible method to deal with different cystic lesions in daily practice.

Keywords: Cystic lesion; diagnosis; endoscopic ultrasound; microbubble; pancreas; puncture.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Workflow for study analysis of contrast-enhanced endoscopic ultrasound
Figure 2
Figure 2
Contrast-enhanced endoscopic ultrasound in low mechanical index mode in a patient with a pancreatic pseudocyst. Because of the echogenic material within the cyst a nodule cannot be excluded in B-mode ultrasound. Contrast-enhanced technique shows no contrast-enhanced effect within the cyst and the cystic wall indicating pancreatic pseudocyst
Figure 3
Figure 3
Series of different imaging methods of a macrocystic serous cystadenoma – diagnosis is based on the endoscopic fine-needle puncture with serous cystic fluid, low carcinoembryonic antigen level and benign cytology. Contrast-enhanced low mechanical index (MI)- endoscopic ultrasound revealed contrast-enhanced effect within the cystic wall as well as in a nodule indicating cystic neoplasia. (a) Three-dimensional (3D) reconstruction of the same lesion shows especially on the left lower area of the cyst the contrast-enhanced effect. (b) High MI contrast-enhanced ultrasound displays Doppler signals from the cystic wall. (c) 3D reconstruction of the same cyst reveals cystic wall vessels (d)
See this image and copyright information in PMC

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