Contrast-enhanced ultrasound of solid pancreatic head lesions: a prospective study

Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of solid pancreatic head lesions (SPHL). Methods This prospective study comprised consecutive patients with SPHL who underwent CEUS evaluation of the pancreas. Findings recorded at CEUS were enhanceme...

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Bibliographic Details
Published in:European radiology 2022-10, Vol.32 (10), p.6668-6677
Main Authors: Gupta, Pankaj, Rana, Pratyaksha, Marodia, Yashi, Samanta, Jayanta, Sharma, Vishal, Sinha, Saroj K., Singh, Harjeet, Gupta, Vikas, Yadav, Thakur Deen, Sreenivasan, Radhika, Vaiphei, Kim, Rajwanshi, Arvind, Kochhar, Rakesh, Sandhu, Manavjit
Format: Article
Language:English
Subjects:
Adenocarcinoma
Algorithms
Carcinoma, Pancreatic Ductal - diagnosis
Contrast Media
Cytology
Diagnosis
Diagnosis, Differential
Diagnostic Radiology
Differential diagnosis
Gastrointestinal
Histopathology
Humans
Image Enhancement
Imaging
Inflammation
Internal Medicine
Interventional Radiology
Lesions
Male
Medicine
Medicine & Public Health
Middle Aged
Multivariate analysis
Neuroendocrine tumors
Neuroradiology
Pancreas
Pancreas - diagnostic imaging
Pancreas - pathology
Pancreatic cancer
Pancreatic Neoplasms
Pancreatic Neoplasms - pathology
Parameter identification
Prospective Studies
Radiology
Sensitivity and Specificity
Tumors
Ultrasonic imaging
Ultrasonography
Ultrasound
Vessels
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Summary:Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of solid pancreatic head lesions (SPHL). Methods This prospective study comprised consecutive patients with SPHL who underwent CEUS evaluation of the pancreas. Findings recorded at CEUS were enhancement patterns (degree, completeness, centripetal enhancement, and percentage enhancement) and presence of central vessels. In addition, time to peak (TTP) and washout time (WT) were recorded. The final diagnosis was based on histopathology or cytology. Multivariate analysis was performed to identify parameters that were significantly associated with pancreatic ductal adenocarcinoma (PDAC). Results Ninety-eight patients (median age 53.8 years, 59 males) were evaluated. The final diagnosis was PDAC ( n = 64, 65.3%), inflammatory mass ( n = 16, 16.3%), neuroendocrine tumor (NET, n = 14, 14.3%), and other tumors ( n = 4, 4.1%). Hypoenhancement, incomplete enhancement, and centripetal enhancement were significantly more common in PDAC than non-PDAC lesions ( p = 0.001, p = 0.031, and p = 0.002, respectively). Central vessels were present in a significantly greater number of non-PDAC lesions ( p = 0.0001). Hypoenhancement with < 30% enhancement at CEUS had sensitivity and specificity of 80.6% and 67.7%, respectively, for PDAC. There was no significant difference in the TTP and WT between PDAC and non - PDAC lesions. However, the WT was significantly shorter in PDAC compared to NET ( p = 0.011). In multivariate analysis, lack of central vessels was significantly associated with a PDAC diagnosis. Conclusion CEUS is a useful tool for the evaluation of SPHL. CEUS can be incorporated into the diagnostic algorithm to differentiate PDAC from non-PDAC lesions. Key Points • Hypoenhancement and incomplete enhancement at CEUS were significantly more common in PDAC than in non-PDAC. • Central vessels at CEUS were significantly associated with PDAC. • There was no difference in TTP and WT between PDAC and non-PDAC lesions.
ISSN:1432-1084
0938-7994
1432-1084
DOI:10.1007/s00330-022-08854-9