Review
Copyright ©The Author(s) 2017.
World J Gastroenterol. Jan 7, 2017; 23(1): 25-41
Published online Jan 7, 2017. doi: 10.3748/wjg.v23.i1.25
Table 1 Descriptors used in harmonic contrast-enhanced endoscopic ultrasound examination
DescriptorsEnhancementPattern of distributionWash-out
Hyper/iso/hypoenhancementHomogenous/inhomogenousSlow/Fast
Corresponding featureArteriolar density compared to the adjacent normal parenchymaVascularity architectureVelocity of the venous blood flow
PhaseArterialArterialVenous
Table 2 Description of solid and cystic pancreatic lesions during harmonic contrast-enhanced endoscopic ultrasound examination
EnhancementPattern of distributionWash-out
Solid pancreatic lesionAdenocarcinomaHypoenhancedHomogenous/non-homogenousFast
NETHyperenhanced > hypoenhancedHomogenous/non-homogenousSlow > Fast
Chronic pancreatitisIsoenhanced/hyperenhanced > hypoenhancedHomogenous/non-homogenousFast
Autoimmune pancreatitisIsoenhanced/hyperenhancedHomogenous/non-homogenousFast
Cystic pancreatic lesionSCAHyperenhancement of the vascularized septae,HomogenousSlow
honeycomb aspect highlighted
MCNHyperenhanced thick walls, thick septa and nodules are predictive for malignancyFast
PseudocystAvascular wall +-
solid component without any contrast uptake
IPMNHyperenhanced septae and vascularized neoplastic nodulesFast
NET cysticHyperenhanced wall and vascularized nodulesSlow
Table 3 Results of contrast-enhanced harmonics-endoscopic ultrasound assessment for solid pancreatic masses in various studies
Ref.Type of studyContrast agentNo. of patientsMIHypoenhancement as a sign of adenocarcinomaEUS diagnostic rateEUS-FNA diagnostic rate
Napoleon et al[18] 2010EndoscopySonovue350.4Sn = 89%Sn = 79%
PC-18Sp = 88%Sp = 100%
NET-9PPV = 89%PPV = 100%
CP-7NPV = 88%NPV = 54%
Acc = 88.5%Acc = 83%
Fusaroli et al[12] 2010ProspectiveSonovue900.36 radialSn = 96%Sn = 86%
PC-51, NET-13, CP-130.28 linearSp = 64%Sp = 18%
Ac = 82%Ac = 57%
Ang et al[19] 2011Definity29 (PC-16, CP-4, Other-9)0.3Better detection of vascular invasion and tumor margins-
Matsubara et al[20] 2011RetrospectiveSonazoid910.2Sn = 87.5%--
Sp = 77.8%
Hocke et al[13] 2012ProspectiveSonovue58-Sn = 84%Sn = 73%-
Sp = 76%Sp = 61%
Kitano et al[15] 2012ProspectiveSonazoid277 (PC-204, NET-19, CrP-46, Other-8)0.3Sn = 95%-Sn = 92%1
Sp = 89%Sp = 100%
Lee et al[16] 2013ProspectiveSonovue37 (PC-28, NET-5, CP-2)-Sn = 93%--
Sp = 86%
PPV = 93%
NPV = 75%
Acc = 92%
Gincul et al[14] 2014ProspectiveSonovue1000.4Sn = 96%Sn = 95%
(PC-69,Sp = 94%Sp = 93%
NET-10, CP-13,PPV = 94%PPV = 100%
Other-8)NPV = 97%NPV = 100%
Acc = 91%Acc = 86%
Park et al[17] 2014RetrospectiveSonovue90-Sn = 91.9%-Sn = 90%
Sp = 67.8%Sp = 100%
Dietrich et al[21] 2016RetrospectiveSonovue394Sn = 92%--
PC-146
NET-156
Table 4 Quantitative assessment studies for differentiating pancreatic masses
Ref.Type of studyType of massContrast agentType of echoendoscopeMIQuantitative assessmentFeatures useful for differentiationDiagnostic rate
Seicean et al[31], 2010ProspectivePC-15SonovueRadial0.36Hue histogramUptake index ratioSn = 80%
CP-12Sp = 91%
PPV = 92.8%
NPV = 78%
Matsubara et al[20], 2011RetrospectivePC-48SonazoidLinear0.20TICEcho intensity reduction rate relative to the peak at 1 minSn = 87.5%
AIP-14Sp = 88.9%
CP-13EUS + TIC
NET-16Sn = 95.8%
Sp = 92.6%
Gheonea et al[25], 2012ProspectiveCP-19SonovueLinear0.20Postprocessing TICPeak intensity intensitySn = 93.7%
PC-32TTPSp = 89.4%
AUC
Imazu et al[32], 2014ProspectiveAIP-8SonazoidRadial0.25-0.3TICPeak intensitySn = 100%
PC-22Maximum intensity gainSp = 100%
Săftoiu et al[33], 2015ProspectivePC-112SonovueLinear0.1-0.3TICPeak intensitySn = 87.5%
CP-55RadialWash-in AUCSp = 92.72%
Wash-in rate
Wash-in perfusion index
Table 5 Contrast-enhanced endoscopic ultrasound for use in characterizing mural nodules in cystic pancreatic lesions
Ref.Type of studyMINo. of patientsType of cystic lesionsContrast substanceDetection of mural nodules accuracyDiagnosis of malignancyCut-off height for malignancy diagnosis(mm)
Yamashita et al[40] 2013Retrospective0.3617IPMNSonazoidEUS-0
CT-71%
CH-EUS-94%
Hocke et al[37] 2014Retrospective0.02-0.181251 MCNSonovueNot definedNot defined-
6 MD-IPMN
16 BD-IPMN
103 others
Harima et al[41] 2015Retrospective-50IPMN BDSonazoidCT-92%8.8 (AUROC = 0.93)
EUS-72%
CH-EUS-98%
Kamata et al[42] 2016Retrospective0.30706 MCN 42 BD-IPMNsSonazoidEUS-73%EUS-64EUS-8 mm (AUROC = 0.84)
4 SCNCH-EUS-84%CH-EUS-84CH-EUS-4 mm (AUROC = 0.93)
18 other
Yamamoto et al[43] 2016Retrospective0.20306/18/2006SonazoidEcho intensity change-0.8No effect on malignancy rate
MD/BD/Mixt IPMNEcho intensity reduction
rate-0.9
Nodule/pancreatic parenchyma contrast ratio-0.89
Table 6 Efficiency of E-endoscopic ultrasound for solid pancreatic mass assessment
Ref.Type of studyFinal diagnosisNo. of patientsE-EUS assessmentMain results
Giovannini et al[58] 2006ProspectiveSurgery24Color patternSn = 100%
Single centerEUS-FNASp = 67%
Janssen et al[75] 2007ProspectiveSurgery73Color pattern-
Single centerEUS-FNA
Săftoiu et al[60] 2008ProspectiveSurgery43Hue histogram cut-off value=175Sn = 91%, Sp = 87%, PPV = 88%. NPV = 90%, Acc = 89%
Single centerEUS-FNA
Iglesias-Garcia et al[72] 2009ProspectiveSurgery130Color patternSn = 100%, Sp = 85%, PPV = 90%, NPV= 100%, Acc = 94%
Single centerEUS-FNA
Giovannini et al[79] 2009ProspectiveSurgery121Color patternSn = 92%
MulticenterEUS-FNASp = 80%
Iglesias-Garcia et al[57] 2010ProspectiveSurgical86SR = 4.62Sn = 100%, Sp = 92%
Single centerFNA
Săftoiu et al[59] 2011ProspectiveSurgery258Hue histogram cut-off value = 175Sn = 93%, Sp = 66%, PPV = 92%, NPV = 68%, Acc = 85%
MulticenterEUS-FNA
Itokawa et al[73] 2011Retrospective109SR=39.08-
Hocke et al[13] 2012ProspectiveSurgical58Color patternSn = 94.7%
Single centerEUS-FNASp = 33.4%
Follow up
Figueiredo et al[71] 2012ProspectiveSurgical47SR = 8Sn = 90% Sp = 75%
Single centerEUS-FNA
Follow up
Dawwas et al[70] 2012ProspectiveSurgical111SR = 4.69 (AUC = 0.69)Sn = 100%, Sp = 16.7%, PPV = 86%, NPV = 100%, Acc = 86%
Single centerEUS-FNAMasks elasticity (AUC= 0.72)Sn = 95%, Sp = 22%, PPV = 86%, NPV = 50%, Acc = 83%
Lee et al[74] 2013Retrospective-15Color pattern-
SR = 0.02%
Havre et al[54] 2014ProspectiveSurgery48SR = 4.4Sn = 67%, Sp = 71%
EUS-FNA
Follow-up
Rustemovic et al[93] 2014ProspectiveSurgery149SR = 7.59Sn = 100%
Single centerEUS-FNASp = 45%
Kongkam et al[69] 2015ProspectiveSurgery38SR=3.17Sn = 86%, Sp = 66%
Single centerEUS-FNA
Opačić et al[94] 2015ProspectiveSurgery105 pancreatic massHue histogramSn = 98%, Sp = 50%, PPV = 92%, NPV = 100%, Ac = 69%
Single centerEUS-FNA44 controls
Mayerle et al[68] 2016ProspectiveSurgery85SR = 24.82 or 10Sn = 77%, Sp = 65%
Single centerEUS-FNASn = 96%, Sp = 43%
Follow-up
Table 7 Efficiency of E-endoscopic ultrasound for LN assessment
Ref.Type of studyFinal diagnosisNo. of patientsE-EUS assessmentMain results
Giovannini et al[58] 2006ProspectiveEUS-FNA31Color patternSn = 100%
Single centerSp = 50%
Janssen et al[75] 2007ProspectiveEUS-FNA66Color patternHard - Acc = 81%-86%
Single centerSoft - Acc = 84%-86%
Săftoiu et al[95] 2007Prospective Single centerSurgery78Hue histogramSn = 85%
EUS-FNASp = 91%
Giovannini et al[79] 2009ProspectiveSurgery101Color patternSn = 91.8%
MulticenterEUS-FNASp = 82.5%
Larsen et al[81] 2012Prospective Single centerSurgery56Color patternSn = 55%-59%
Sp = 82%-85%
Paterson et al[78] 2012ProspectiveEUS-FNA53Strain ratio for malignancy = 7.5Sn = 83%, Sp = 96%, PPV = 95%, NPV = 86%, Acc = 90%
Single center
Knabe et al[83] 2013ProspectiveEUS-FNA40Color patternSn = 100%
Computed analysisSp = 64%
Computed analysis
Sn = 88.9%
Sp = 86.7%
Table 8 Needle confocal laser endosonography features of different cystic lesions of the pancreas
Type of lesionnCLE featuresDiagnostic rate, references
SCAA vascular network of the cystic wallSn = 69%, Sp = 100%, PPV = 100%, NPV = 82%[100]
MCNA gray band delineated by a thin dark lineSn = 80%, Sp = 100%[103]
Sn = 67%, Sp = 96%[100]
IPMNPapillary projections: characterized by the alternation of vascular cores (white) and epithelial bordersSn = 59%, Sp = 100%[102]
Sn = 80%, Sp = 92%[100]
PseudocystInflammatory cells bright, gray and black particlesSn = 43%, Sp = 100%, Acc = 87%[100]
Cystic NETDark irregular clusters of compact cells + gray tissue of fibrovascular stromaSn = 67%, Sp = 96%, Acc = 90%[100]