RESUMEN
PURPOSE: To compare contrast-enhanced transabdominal ultrasonography (CE-US) following contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) with enhanced magnetic resonance imaging using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB-MRI) in the diagnosis of liver metastases in patients with pancreatic cancer. METHODS: Patients who underwent contrast-enhanced computed tomography for possible pancreatic cancer and required further evaluation with CH-EUS were enrolled in this study, and the diagnostic performance of CE-US following CH-EUS for liver metastasis was compared with that of EOB-MRI. RESULTS: A total of 228 patients were included in the final analysis. Two hundred thirty-four hepatic lesions were found in 81 patients, and 178 lesions were finally diagnosed as metastases. EOB-MRI had a higher sensitivity (0.837 vs 0.949), while CE-US had a higher specificity and positive predictive value (PPV) (0.982 and 0.993 vs 0.911 and 0.971, respectively) in the diagnosis of liver metastasis. CE-US with defect reperfusion imaging had a higher diagnostic performance than EOB-MRI (0.866 vs 0.667) in the differentiation between liver metastasis and abscess. CONCLUSION: EOB-MRI had a higher sensitivity than CE-US for diagnosing liver metastasis in patients with pancreatic cancer, but CE-US following CH-EUS demonstrated a higher specificity and PPV than EOB-MRI and was especially useful in the differentiation between liver metastasis and abscess.
Asunto(s)
Neoplasias Hepáticas , Neoplasias Pancreáticas , Absceso , Medios de Contraste , Endosonografía , Gadolinio DTPA , Humanos , Neoplasias Hepáticas/patología , Imagen por Resonancia Magnética/métodos , Neoplasias Pancreáticas/diagnóstico por imagen , Ultrasonografía/métodos , Neoplasias PancreáticasRESUMEN
A 65-year-old woman with a history of treatment for splenic marginal zone B-cell lymphoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma underwent esophagogastroduodenoscopy. A reddish elevated lesion was found in the fundus of the stomach. On image-enhanced endoscopy, several findings, such as glandular structures of varying sizes suggesting well-differentiated adenocarcinoma, pruned blood vessels, and dilated blood vessels in deeper mucosa suggesting MALT lymphoma, were observed. The final pathological diagnosis after surgical resection was collision tumors of well-differentiated adenocarcinoma and MALT lymphoma. The features of both tumors could be observed simultaneously with image-enhanced endoscopy.
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Adenocarcinoma , Infecciones por Helicobacter , Helicobacter pylori , Linfoma de Células B de la Zona Marginal , Neoplasias Gástricas , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Anciano , Endoscopía del Sistema Digestivo , Femenino , Mucosa Gástrica , Humanos , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/cirugíaRESUMEN
PURPOSE: Pancreatic fibrosis or fibrosing reactions have been reported in intraductal papillary-mucinous neoplasm (IPMN) patients. We assessed whether a higher elastic modulus (EM) measured using shear wave elastography (SW-EG) correlated with the existence of branch-duct (BD) IPMN. METHODS: In total, 183 normal pancreas (NP) and 123 BD-IPMN cases were enrolled. First, we assessed the difference in pancreatic EM (PEM) at different sites (head or tail side of the cyst). Second, a comparison was done between the median PEM of the NP and the BD-IPMN cases. Receiver-operating characteristic analysis was performed to determine the BD-IPMN diagnostic capabilities. Finally, in patients whose cyst was not visualized, the test-positive rate was determined. RESULTS: No significant difference was seen between the cyst head side PEM (4.61 kPa) and the tail side PEM (5.35 kPa) (P = 0.471). Among these cases matched by age, 73 were selected each from NP and BD-IPMN cases (median age 65 years). The median PEM of the BD-IPMN cases (5.18 kPa) was significantly higher than that of the NP cases (3.17 kPa) (P < 0.001). When the cut-off value was set at 4.75 kPa, the sensitivity, specificity, PPV, NPV, and accuracy were 75.3%, 64.4%, 72.3%, 67.9%, and 69.9%, respectively. The cut-off value of 4.75 kPa helped for the indirect selection of BD-IPMN patients (10/17, 58.8%) whose cyst was not detected on B-mode ultrasonography. CONCLUSION: SW-EG measurement of the underlying pancreatic parenchyma may correlate with the presence of BD-IPMN.
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Diagnóstico por Imagen de Elasticidad/métodos , Neoplasias Intraductales Pancreáticas/diagnóstico por imagen , Neoplasias Intraductales Pancreáticas/patología , Adulto , Anciano , Anciano de 80 o más Años , Módulo de Elasticidad , Femenino , Fibrosis/diagnóstico por imagen , Fibrosis/patología , Humanos , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Páncreas/patología , Conductos Pancreáticos/diagnóstico por imagen , Conductos Pancreáticos/patología , Curva ROC , Estudios RetrospectivosRESUMEN
Evaluation of the pancreatic elastic modulus (PEM) using shear wave elastography (SWE) requires at least 5 measurements to ensure reproducibility. The aim of this study was to evaluate improvement in reproducibility of SWE, using the propagation display method in normal pancreas ([NP] phase 1) and to examine the differences in PEM between NP and chronic pancreatitis (CP), intraductal papillary mucinous neoplasm (IPMN) and autoimmune pancreatitis ([AIP] phase 2). In phase 1, the measurement success rate, median PEM in repeated measurements and appropriate number of SWE measurements were determined in 109 cases with NP. In phase 2, PEM was measured in CP (nâ¯=â¯10), IPMN (nâ¯=â¯31) and AIP (nâ¯=â¯5), using the required number of SWE measurements determined in phase 1. In phase 1, the measurement success rate was 93.9% (92/109 cases). The median PEM for NP was 14.6 kPa and the appropriate number of SWE measurements was at least 3. In phase 2, the median PEMs in CP, IPMN and AIP were 19.6, 18.1 and 17.2 kPa, respectively, with significant differences between NP and CP (pâ¯=â¯0.0133) and between NP and IPMN (pâ¯=â¯0.0436). Use of the propagation display method in SWE improves the reproducibility of measurement of PEM.
Asunto(s)
Pancreatitis Autoinmune/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad/métodos , Interpretación de Imagen Asistida por Computador/métodos , Neoplasias Intraductales Pancreáticas/diagnóstico por imagen , Pancreatitis Crónica/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Pancreatitis Autoinmune/fisiopatología , Diagnóstico Diferencial , Módulo de Elasticidad/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Páncreas/fisiología , Neoplasias Intraductales Pancreáticas/fisiopatología , Pancreatitis Crónica/fisiopatología , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Hydrogen is produced from unabsorbed carbohydrates in the intestine through degradation and metabolism by hydrogenase of intestinal bacteria. The hydrogen is then partially diffused into blood flow and released and detected in exhaled breath. Pancreatic juice production is decreased in patients with reduced pancreatic exocrine function, including those with pancreatic cancer, thus decreasing digestion and absorption of nutrients including carbohydrates, which may increase undigested carbohydrates in the intestine and increase breath hydrogen concentration (BHC). The aim of this study was to investigate the association between BHC and pancreatic diseases. METHODS: A retrospective study was designed and 68 patients underwent morning fasting breath hydrogen test. Since there is no clear standard, normal BHC, the median of the measured values from the subjects (9 ppm) was adopted as the standard. The subjects were classified into those with a value exceeding the median (BHC high group: 32 patients) and a value equal to or below the median (BHC low group: 36 patients). Patients characteristics, blood test results and imaging findings characteristic of pancreatic diseases were compared between the groups. RESULTS: The age was significantly higher (P = 0.010) and the incidences of pancreatic ductal adenocarcinoma and autoimmune pancreatitis were significantly higher (P = 0.018 and P = 0.004, respectively) in the BHC high group. With respect to the blood test items, the Alb level was significantly lower in the BHC high group (P = 0.005). With respect to the characteristic imaging findings of pancreatic diseases, the proportions of patients with pancreatic enlargement, the main pancreatic duct (MPD) stenosis, and the MPD dilatation were significantly higher in the BHC high group (P = 0.022, P < 0.001, and P = 0.002, respectively). On univariate analysis, only the MPD stenosis was extracted as an independent factor (P = 0.014). CONCLUSION: It was suggested that the fasting BHC is associated with pancreatic diseases causing stenosis of the MPD, including pancreatic cancer (UMIN000020777).
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Pruebas Respiratorias/métodos , Hidrógeno/análisis , Conductos Pancreáticos/patología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Constricción Patológica , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/sangre , Enfermedades Pancreáticas/diagnóstico , Pancreatitis , Sistema Respiratorio/patología , Estudios RetrospectivosRESUMEN
BACKGROUND: It is difficult to diagnose chronic pancreatitis (CP) objectively because of a lack of standard diagnostic criteria. Endoscopic ultrasonography (EUS) has been used to assess the severity of CP, but the diagnosis of CP using EUS depends on an endosnonographer. The aim of this study was to establish an objective diagnostic method for CP using EUS elastography (EUS-EG). METHODS: A retrospective study was designed and 96 patients underwent EUS-EG for follow-up of known CP, or who were clinically suspected as having CP. CP patients were categorized CP patients as 4 stages using the Rosemont classification (RC). EUS-EG was performed and the "Mean value", which was negatively correlated with pancreatic fibrosis, was calculated using histogram analysis. RESULTS: The "Mean value" of each RC stage (normal, indeterminate for CP, suggestive of CP, and consistent with CP) was 90.1 ± 19.3, 73.2 ± 10.6, 63.7 ± 14.2, and 56.1 ± 13.6, respectively, and showed significant differences for each stage (p < 0.001). There was a significant negative correlation between the "Mean value" and the number of EUS features (r s = -0.59, p < 0.001). Multiple linear regression analysis was used to assess the diagnostic finding of the "Mean value" and showed that hyperechoic foci with shadowing and lobularity with honeycombing maintained their independent diagnostic findings. CONCLUSIONS: EUS-EG was an objective diagnostic apparatus for CP and provided objective information to support EUS features.
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Diagnóstico por Imagen de Elasticidad/métodos , Endosonografía , Pancreatitis Crónica/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
A 58-year-old man came to our hospital, complaining of diarrhea and bloody stool of about 2 weeks' duration. Colonoscopic examination showed mucosal edema and bleeding, and irregular ulcer in the transverse colon and sigmoid colon. Laboratory data indicated elevated WBC (22300/mm(3)) and CRP (11.93mg/dl), and hypereosinophilia (30%). We diagnosed ischemic colitis with thrombosis due to hypereosinophilic syndrome. He started medication with prednisolone and heparin. However, after 15 days, he underwent emergency surgery because of perforation of the sigmoid colon. Thrombosis is associated with a high incidence of hypereosinophilia. It is important to consider the possibility of ischemic colitis associated with hypereosinophilic syndrome.