Contrast-enhanced endoscopic ultrasound.

Compared to other imaging modalities, endoscopic ultrasound (EUS) has limitations in terms of image enhancement. However, with the availability of contrast agents in ultrasonography, EUS has evolved. Contrast-enhanced Doppler EUS (CD-EUS) enhances Doppler signals from vessels and is useful for characterizing lesions detected by EUS. Moreover, contrast-enhanced harmonic EUS (CH-EUS) with second-generation ultrasound contrast agents and a broad band transducer allows microvessels and parenchymal perfusion to be visualized. Vascularity can also be quantitatively analyzed during CH-EUS by generating a time-intensity curve. CE-EUS is useful for characterizing pancreatic lesions and can detect pancreatic adenocarcinomas with a sensitivity of 94%and a specificity of 89% as a result of the hypo-enhancement of these lesions. Indeed, CH-EUS is superior to multiple detector-computed tomography in terms of the differential diagnosis of small lesions that are ≤2 cm. CH-EUS complements EUS-guided fine-needle aspiration (EUS-FNA) as it identifies the EUS-FNA target and lesions with false-negative EUS-FNA findings. CH-EUS is also used to estimate the malignant potential of gastrointestinal stromal tumors and helps to differentiate between malignant and benign lymphadenopathy.