OBJECTIVES: To use subharmonic imaging (SHI) to depict the vascularity of pancreatic masses compared to contrast-enhanced endoscopic ultrasound (EUS) and pathologic results. METHODS: Sixteen patients scheduled for biopsy of a pancreatic mass were enrolled in an Institutional Review Board-approved study. Pulse-inversion SHI (transmitting/receiving at 2.5/1.25 MHz) was performed on a LOGIQ 9 system (GE Healthcare, Milwaukee, WI) with a 4C transducer, whereas contrast harmonic EUS (transmitting/receiving at 4.7/9.4 MHz) was performed with a radial endoscope (GF-UTC180; Olympus Corporation, Tokyo, Japan) connected to a ProSound SSD α-10 scanner (Hitachi Aloka, Tokyo, Japan). Two injections of the contrast agent Definity (Lantheus Medical Imaging, North Billerica, MA) were administrated (0.3-0.4 and 0.6-0.8 mL for EUS and SHI, respectively). Contrast-to-tissue ratios (CTRs) in the mass and an adjacent vessel were calculated. Four physicians independently scored the images (benign to malignant) for diagnostic accuracy and inter-reader agreement. RESULTS: One patient dropped out before imaging, leaving 11 adenocarcinomas, 1 gastrointestinal stromal tumor with pancreatic infiltration, and 3 benign masses. Marked subharmonic signals were obtained in all patients, with intratumoral blood flow clearly visualized with SHI. Significantly greater CTRs were obtained in the masses with SHI than with EUS (mean ± SD, 1.71 ± 1.63 versus 0.63 ± 0.89; P = .016). There were no differences in the CTR in the surrounding vessels or when grouped by pathologic results (P > .60). The accuracies for contrast EUS and SHI were low (<53%), albeit with a greater κ value for SHI (0.34) than for EUS (0.13). CONCLUSIONS: Diagnostic accuracy of contrast EUS and transabdominal SHI for assessment of pancreatic masses was quite low in this pilot study. However, SHI had improved tumoral CTRs relative to contrast EUS.
OBJECTIVES: To use subharmonic imaging (SHI) to depict the vascularity of pancreatic masses compared to contrast-enhanced endoscopic ultrasound (EUS) and pathologic results. METHODS: Sixteen patients scheduled for biopsy of a pancreatic mass were enrolled in an Institutional Review Board-approved study. Pulse-inversion SHI (transmitting/receiving at 2.5/1.25 MHz) was performed on a LOGIQ 9 system (GE Healthcare, Milwaukee, WI) with a 4C transducer, whereas contrast harmonic EUS (transmitting/receiving at 4.7/9.4 MHz) was performed with a radial endoscope (GF-UTC180; Olympus Corporation, Tokyo, Japan) connected to a ProSound SSD α-10 scanner (Hitachi Aloka, Tokyo, Japan). Two injections of the contrast agent Definity (Lantheus Medical Imaging, North Billerica, MA) were administrated (0.3-0.4 and 0.6-0.8 mL for EUS and SHI, respectively). Contrast-to-tissue ratios (CTRs) in the mass and an adjacent vessel were calculated. Four physicians independently scored the images (benign to malignant) for diagnostic accuracy and inter-reader agreement. RESULTS: One patient dropped out before imaging, leaving 11 adenocarcinomas, 1 gastrointestinal stromal tumor with pancreatic infiltration, and 3 benign masses. Marked subharmonic signals were obtained in all patients, with intratumoral blood flow clearly visualized with SHI. Significantly greater CTRs were obtained in the masses with SHI than with EUS (mean ± SD, 1.71 ± 1.63 versus 0.63 ± 0.89; P = .016). There were no differences in the CTR in the surrounding vessels or when grouped by pathologic results (P > .60). The accuracies for contrast EUS and SHI were low (<53%), albeit with a greater κ value for SHI (0.34) than for EUS (0.13). CONCLUSIONS: Diagnostic accuracy of contrast EUS and transabdominal SHI for assessment of pancreatic masses was quite low in this pilot study. However, SHI had improved tumoral CTRs relative to contrast EUS.
Authors: Anush Sridharan; John R Eisenbrey; Priscilla Machado; Haydee Ojeda-Fournier; Annina Wilkes; Alexander Sevrukov; Robert F Mattrey; Kirk Wallace; Carl L Chalek; Kai E Thomenius; Flemming Forsberg Journal: IEEE Trans Ultrason Ferroelectr Freq Control Date: 2015-03 Impact factor: 2.725
Authors: Valgerdur G Halldorsdottir; Jaydev K Dave; Lauren M Leodore; John R Eisenbrey; Suhyun Park; Anne L Hall; Kai Thomenius; Flemming Forsberg Journal: Ultrason Imaging Date: 2011-07 Impact factor: 1.578
Authors: Jaydev K Dave; Flemming Forsberg; Savitha Fernandes; Catherine W Piccoli; Traci B Fox; Daniel A Merton; Lauren M Leodore; Anne L Hall Journal: J Ultrasound Med Date: 2010-08 Impact factor: 2.153
Authors: John R Eisenbrey; Jaydev K Dave; Valgerdur G Halldorsdottir; Daniel A Merton; Cynthia Miller; José M Gonzalez; Priscilla Machado; Suhyun Park; Scott Dianis; Carl L Chalek; Christopher E Kim; Jeffrey P Baliff; Kai E Thomenius; Daniel B Brown; Victor Navarro; Flemming Forsberg Journal: Radiology Date: 2013-03-22 Impact factor: 11.105
Authors: C J Yeo; J L Cameron; K D Lillemoe; J V Sitzmann; R H Hruban; S N Goodman; W C Dooley; J Coleman; H A Pitt Journal: Ann Surg Date: 1995-06 Impact factor: 12.969