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. 2017 Aug 28;23(32):5962-5968.
doi: 10.3748/wjg.v23.i32.5962.

Real time endoscopic ultrasound elastography and strain ratio in the diagnosis of solid pancreatic lesions

Hussein Okasha  1 , Shaimaa Elkholy  2 , Ramy El-Sayed  3 , Mohamed-Naguib Wifi, Mohamed El-Nady, Walid El-Nabawi  4 , Waleed A El-Dayem  3 , Mohamed I Radwan  3 , Ali Farag, Yahya El-Sherif  5 , Emad Al-Gemeie  6 , Ahmed Salman, Mohamed El-Sherbiny, Ahmed El-Mazny, Reem E Mahdy  7
Affiliations

Real time endoscopic ultrasound elastography and strain ratio in the diagnosis of solid pancreatic lesions

Hussein Okasha et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions (SPL).

Methods: A total of 172 patients with SPL identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and strain ratio in differentiating malignant from benign lesions. The semi quantitative score of elastography was represented by the strain ratio method. Two areas were selected, area (A) representing the region of interest and area (B) representing the normal area. Area (B) was then divided by area (A). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by comparing diagnoses made by elastography, strain ratio and final diagnoses.

Results: SPL were shown to be benign in 49 patients and malignant in 123 patients. Elastography alone had a sensitivity of 99%, a specificity of 63%, and an accuracy of 88%, a PPV of 87% and an NPV of 96%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 7.8 with a sensitivity of 92%, specificity of 77%, PPV of 91%, NPV of 80% and an accuracy of 88%. Another estimated cut off strain ratio level of 3.8 had a higher sensitivity of 99% and NPV of 96%, but with less specificity, PPV and accuracy 53%, 84% and 86%, respectively. Adding both elastography to strain ratio resulted in a sensitivity of 98%, specificity of 77%, PPV of 91%, NPV of 95% and accuracy of 92% for the diagnosis of SPL.

Conclusion: Combining elastography to strain ratio increases the accuracy of the differentiation of benign from malignant SPL.

Keywords: Elastography; Endoscopic Ultrasound; Pancreatic lesions; Real Time; Strain Ratio.

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Conflict of interest statement

Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A patient with chronic pancreatitis showing heterogeneous soft tissue (green, yellow, and red), and interpreted as fibrosis or inflammation.
Figure 2
Figure 2
A patient with elasticity score 3 showing mixed hard and soft tissues (mixed colors) or a honeycombed elastography pattern, interpreted as indeterminate for malignancy.
Figure 3
Figure 3
A patient with autoimmune pancreatitis showing elasticity score 3.
Figure 4
Figure 4
A patient with advanced malignant lesions with necrotic areas (elasticity score 5) showing predominantly hard (blue) lesion with dispersed heterogenic soft (green) areas.
Figure 5
Figure 5
A patient with pancreatic head malignancy showing high stain ratio (25.86).
Figure 6
Figure 6
A patient with pancreatic head malignancy showing very high stain ratio (45.34).
See this image and copyright information in PMC

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