Quantitative perfusion analysis in pancreatic contrast enhanced ultrasound (DCE-US): a promising tool for the differentiation between autoimmune pancreatitis and pancreatic cancer

Abstract

In the work-up of focal pancreatic lesions autoimmune pancreatitis (AIP) is a rare differential diagnosis to pancreatic cancer (PC) with similar clinical constellations. The aim of our study was to compare differences between proven AIP and PC using transabdominal dynamic contrast enhanced ultrasound (DCE-US). Therefore we recorded 3-minute-clips of CEUS examinations and analyzed perfusion parameters with VueBox^®-quantification software. To obtain DCE-US Parameters, Regions-of-Interest were selected within the lesions and the surrounding pancreas parenchyma, serving as reference tissue. We compared 3 patients with AIP (mean age: 58 years; lesion mean size: 40 mm) to 17 patients with PC (mean age: 68 years; lesion mean size: 35.9 mm). Significant differences between PC and parenchyma could be found in the following parameters: Peak-Enhancement (PE), Wash-in-and-Wash-out-AUC, Wash-in Perfusion-Index. PE of AIP was comparable to normal parenchyma. The relation of PE between parenchyma and lesion (ΔPE) AIP and PC was significantly different [AIP: 0.21 (± 0.06); PC: 0.81 (± 0.1); p < 0.01]. PE of neoplastic lesions was significantly lower as AIP and normal parenchyma (p < 0.01). Therefore perfusion analysis in DCE-US can help to differentiate hypovascular PC from AIP presenting nearly isovascular time intensity curves. Diagnostic accuracy of DCE-US in this setting has to be validated in future prospective studies in comparison to CT and MRI.

Zusammenfassung

In der Abklärung fokaler Pankreasläsionen stellt die Autoimmunpankreatitis (AIP) eine seltene Differenzialdiagnose zum Pankreaskarzinom (PC) mit vergleichbarer klinischer Symptomkonstellation dar. Ziel der vorliegenden Arbeit war es zu untersuchen, ob die dynamische transabdominelle Kontrastmittelsonografie (DCE-US) Unterschiede zwischen gesicherten AIP und PC darstellen kann. Videoclips der Kontrastmittelsonografie nach Bolusinjektion von SonoVue^® wurden über 3 Minuten aufgezeichnet und mittels Quantifizierungs-Software (VueBox^®) ausgewertet. Die Quantifikationsparameter wurden durch einen Messbereich innerhalb der Pankreasläsion bestimmt und mit denen des angrenzenden gesunden Pankreasparenchyms als intraindividuelle Referenz verglichen. Es wurden 3 AIP-Patienten (mittleres Alter: 58 Jahre; mittlere Läsionsgröße: 40 mm) und 17 PC-Patienten (mittleres Alter: 68 Jahre; mittlere Läsionsgröße: 35,9 mm) untersucht. Signifikante Unterschiede zeigten sich zwischen Parenchym und PC in folgenden DCE-US-Parametern: Peak-Enhancement (PE), Wash-in-and-Wash-out-AUC, Wash-in Perfusion-Index. DCE-US Parameter der AIP zeigten vergleichbare Werte zum umliegenden, morphologisch unauffälligen, Parenchym. Das Verhältnis des PE zwischen Parenchym und Läsion (ΔPE) war signifikant unterschiedlich [AIP: 0,21 (± 0,06); PC: 0,81 (± 0,1); p < 0,01]. Die Analyse der Perfusionskinetik mittels DCE-US kann helfen, das hypovaskularisierte PC von der nahezu isovaskularisierten AIP zu unterscheiden. Die diagnostische Treffsicherheit der quantitativen Kontrastmittelsonografie muss in prospektiven Studien im Vergleich zur CT und MRT validiert werden.

Schlüsselwörter

Kontrastmittelsonografie - Pankreaskarzinom - Autoimmunpankreatitis - quantifizierende Perfusionsanalyse

Key words

contrast enhanced ultrasound - pancreatic adenocarcinoma - autoimmune pancreatitis - quantitative perfusion analysis

^* Drs. Vitali and Pfeifer contributed equally to this article.

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