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. 2024 Jul-Aug;13(4):248-252.
doi: 10.1097/eus.0000000000000076. Epub 2024 Aug 23.

Detective flow imaging versus contrast-enhanced EUS in solid pancreatic lesions

Maria Victoria Mulqui  1 , Fabrice Caillol  1 , Jean Philippe Ratone  1 , Solène Hoibian  1 , Yanis Dahel  1 , Élise Meunier  1 , Clément Archimbaud  1 , Marc Giovannini  1
Affiliations

Detective flow imaging versus contrast-enhanced EUS in solid pancreatic lesions

Maria Victoria Mulqui et al. Endosc Ultrasound. 2024 Jul-Aug.

Abstract

Background and objectives: Detective flow imaging EUS (DFI-EUS) is a new technology that detects fine vessels and low-flow velocity without contrast agents, used in real time during EUS, with a better resolution compared to usual technologies such as color Doppler and eFLOW. The aim of this study was to compare DFI-EUS with contrast-enhanced EUS (CE-EUS) for the evaluation of vascularization in solid pancreatic lesions.

Methods: We included patients who had a pancreatic mass visualized by EUS, with recorded images of their assessment in DFI-EUS and CE-EUS techniques and a histological diagnosis confirmed malignant tumors or a minimum of 1-year follow-up for benign lesions.

Results: Of the 107 patients included in this retrospective single-center study, the histological diagnosis revealed 69 cases (64.5%) of pancreatic adenocarcinoma, 18 cases (16.8%) of neuroendocrine tumors (NETs), and 10 cases (9.3%) of metastases from nonpancreatic cancers. A smaller proportion (9.4%) exhibited other lesions. As a result, the incidence of intralesional microvascularization was 43.9% with DFI-EUS and 48.6% with CE-EUS, indicating a positive correlation between the 2 techniques (P = 0.0001). Compared to CE-EUS, DFI-EUS exhibited sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88.5%, 98.2%, 97.9%, and 90%, respectively, for the detection of intralesional vessels.

Conclusions: The novel technique DFI-EUS demonstrates a remarkable correlation with CE-EUS, exhibiting high sensitivity and specificity for the assessment of microvascularization in solid pancreatic lesions. This method eliminates the need for a contrast agent, thus carrying no risk of adverse effects.

Keywords: Contrast-enhanced EUS; Detective flow imagine EUS; Doppler EUS; Pancreatic cancer; Solid pancreatic lesions.

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Conflict of interest statement

Marc Giovannini is a Founding Editor-in-Chief of the journal. The article was subjected to the standard procedures of the journal, with a review process independent of the editors and their research group. The other authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Examples of endosonographic images showing pancreatic lesions, from the left to the right, in B-mode, DFI-EUS, and CE-EUS. (A) A case of pancreatic adenocarcinoma. (B) A case of neuroendocrine tumor. (C) A case of pancreatic metastasis. (D) A case of accessory spleen. CE-EUS: contrast-enhanced EUS; DFI-EUS: detective flow imaging EUS.
Figure 2
Figure 2
Evaluation of the microvascularity with DFI-EUS and CE-EUS in solid pancreatic lesions. CE-EUS: contrast-enhanced EUS; DFI-EUS: detective flow imaging EUS.
Figure 3
Figure 3
Comparison between DFI-EUS with CE-EUS in the assessments of solid pancreatic lesions. CE-EUS: contrast-enhanced EUS; DFI-EUS: detective flow imaging EUS.
See this image and copyright information in PMC

References

    1. Teshima CW, Sandha GS. Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease. World J Gastroenterol 2014;20(29):9976–9989. doi:10.3748/wjg.v20.i29.9976. PMID: 25110426; PMCID: PMC4123377. - DOI - PMC - PubMed
    1. Kitano M, Yoshida T, Itonaga M, Tamura T, Hatamaru K, Yamashita Y. Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer. J Gastroenterol 2019;54(1):19–32. doi:10.1007/s00535-018-1519-2. PMID: 30406288; PMCID: PMC6314985. - DOI - PMC - PubMed
    1. Yamaguchi K Okusaka T Shimizu K, et al. . Clinical practice guidelines for pancreatic cancer 2016 from the Japan Pancreas Society: a synopsis. Pancreas 2017;46:595–604. - PubMed
    1. Giovannini M. Contrast-enhanced endoscopic ultrasound and elastosonoendoscopy. Best Pract Res Clin Gastroenterol 2009;23:767–779. - PubMed
    1. Kitano M Sakamoto H Matsui U, et al. . A novel perfusion imaging technique of the pancreas: contrast-enhanced harmonic EUS (with video). Gastrointest Endosc 2008;67(1):141–150. doi:10.1016/j.gie.2007.07.045. PMID: 18155437. - DOI - PubMed