A Novel Endoscopic Ultrasonography Imaging Technique for Depicting Microcirculation in Pancreatobiliary Lesions without the Need for Contrast-Enhancement: A Prospective Exploratory Study.

Yasunobu Yamashita,Yoshiyuki Ida,Mikitaka Iguchi,Masayuki Kitano,Reiko Ashida,Takashi Tamura,Masahiro Itonaga,Yuki Kawaji,Hirofumi Yamazaki,Takao Maekita,Takanori Yoshikawa,Keiichi Hatamaru

doi:10.3390/diagnostics11112018

Yasunobu Yamashita, Yoshiyuki Ida + Show 10 more

Open Access

https://doi.org/10.3390/diagnostics11112018

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Journal: Diagnostics	Publication Date: Oct 30, 2021
Citations: 13	License type: CC BY 4.0

Affiliation: Wakayama Medical University

Abstract

Detective flow imaging endoscopic ultrasonography (DFI-EUS) provides a new method to image and detect fine vessels and low-velocity blood flow without using ultrasound contrast agents. The aim of this study was to evaluate the utility of DFI-EUS for pancreatobiliary lesions and lymph nodes. Between January 2019 and January 2020, 53 patients who underwent DFI-EUS, e-FLOW EUS, and contrast-enhanced EUS were enrolled. The ability of DFI-EUS and e-FLOW EUS to detect vessels was compared with that of contrast-enhanced EUS. This article describes the DFI technique along with our first experience of its use for vascular assessment of pancreatobiliary lesions. Vessels were imaged in 34 pancreatic solid lesions, eight intraductal papillary mucinous neoplasms (IPMNs), seven gall bladder lesions, and four swollen lymph nodes. DFI-EUS (91%) was significantly superior to e-FLOW EUS (53%) with respect to detection of vessels (p < 0.001) and for discrimination of mural nodules from mucous clots in IPMN and gallbladder lesions from sludge (p = 0.046). Thus, DFI-EUS has the potential to become an essential tool for diagnosis and vascular assessment of various diseases.

Highlights

Ultrasonography (US) is a common non-invasive and radiation-free technique for diagnosis
We examined the utility of Detective flow imaging endoscopic ultrasonography (DFI-Endoscopic ultrasonography (EUS)) for pancreatobiliary lesions and lymph node swelling and compared the results with those of e-FLOW, which is another kind of directional power Doppler ultrasonography with greater spatial and temporal resolution than conventional color and power Doppler EUS) [4] and CE-EUS
The gallbladder sludge and the mucous clot in intraductal papillary mucinous neoplasms (IPMNs) were diagnosed by CE-EUS in the absence of vascularity

Summary

Introduction

Ultrasonography (US) is a common non-invasive and radiation-free technique for diagnosis. Endoscopic ultrasonography (EUS) was developed in the 1980s to overcome the problems caused by intervening gas, bone, and fat, which have adverse effects on transabdominal US images. EUS is thought to be one of the most reliable and efficient diagnostic modalities for pancreatobiliary disease because of its superiority to other modalities with respect to spatial resolution [1,2,3]. EUS is useful for detecting small lesions. It is difficult to obtain a differential diagnosis based solely on EUS imaging characteristics, because most lesions appear hypoechoic on EUS

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