#Paradigm shift images serial
In the near future, CH-EUS may provide new diagnostic value in terms of differentiating functional and histological features within the same histopathological category based on serial changes in blood flow. 4, 5 However, “atypical enhancement behavior” may have deeper implications in the characterization of the tumors. To overcome these issues and improve the diagnostic ability of CH-EUS, several evaluations of vascularity have been proposed, such as a quantitative evaluation method using TIC analysis and a multiphase evaluation method. Due to the presence of tumors with atypical enhancement behavior, there may be limitations to making a complete differential diagnosis with uniform qualitative diagnostic criteria. Although these data show the usefulness of CH-EUS in the differential diagnosis of pancreatic tumors, even among PDAC or PanNEN, some lesions show “atypical enhancement behavior” based on the qualitative diagnostic criteria by CH-EUS. 3 reported that the diagnostic ability of CH-EUS for pancreatic cancer has a pooled sensitivity of 93% (91–95%) and specificity of 80% (75–85%) based on a meta-analysis. Generally, hypoenhancement/heterogeneous enhancement indicates pancreatic ductal adenocarcinoma (PDAC), isoenhancement is diagnosed as mass-forming pancreatitis, and hyperenhancement is diagnosed as pancreatic neuroendocrine neoplasms (PanNEN). Typically, the diagnosis of solid pancreatic tumors by CH-EUS is made based on a qualitative assessment.
#Paradigm shift images software
Due to the evolution of diagnostic imaging software in ultrasonic observation systems and the expansion of applications for second-generation ultrasonic contrast media, the amount of information that can be obtained from CH-EUS is increasing dramatically. More than 20 years have passed since the first report of contrast-enhanced EUS, and recent development of contrast-enhanced harmonic EUS (CH-EUS) for the evaluation of vascularity may provide a more detailed or deeper characterization of pancreatic and intra-abdominal lesions. Since then, it has contributed to the differential diagnosis of lesions as a method for evaluating vascularity in the gastrointestinal tract and biliary pancreatic region. 1 in 1995 as endoscopic ultrasonographic angiography by using CO 2 microbubbles as a contrast medium. However, generally, since solid pancreatic tumors are visualized as hypoechoic masses on B-mode images of EUS, differential diagnosis is limited by using only B-mode morphological findings.Ĭontrast-enhanced EUS was first introduced by Kato et al. EUS plays an indispensable role as a highly sensitive diagnostic imaging method and as a tool for performing EUS-fine needle aspiration (FNA). In pancreatic disease diagnosis, endoscopic ultrasonography (EUS) has superior spatial resolution compared to transabdominal ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI).
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