Accuracy of transabdominal ultrasound 2D Shear Wave Elastography compared to endoscopic ultrasound in the diagnosis of chronic pancreatitis

Aims Diagnosis of chronic pancreatitis (CP) is still challenging, especially in early stages, when typical clinical signs and parenchymal changes are lacking. By now, evaluation of the pancreatic gland by endoscopic ultrasound (EUS) using Rosemont criteria (RC) is the gold-standard, although it is limited by invasiveness, cost and suboptimal accuracy.

Therefore, it is of crucial interest to develop non expensive, widely applicable tests for the diagnosis of CP. Recently the Gemelli chronic pancreatitis ultrasound score (USCP) has been developed to fill in this gap. Comparable to liver stiffness measurement, transabdominal ultrasound with 2D shear wave elastography (2D SWE) could represent an additional alternative for the diagnosis of CP.

Methods We conducted a single center, prospective, case control study where EUS with Rosemont criteria defined patient cohorts with chronic pancreatitis or absence of parenchymal changes. Patients with and without CP subsequently underwent transabdominal ultrasound with evaluation of the pancreas using 2D SWE (in m/s) and characterization by the USCP score. All examinations were performed with the LogiqE10 (GE Healthcare). Primary outcome was the agreement between the different evaluation techniques, most importantly between Rosemont score and 2D SWE. Secondary outcome was the evaluation of a cut off value of SWE differentiating values in CP from normal values.

Results A total of 50 patients with CP and 28 without CP were included between may and October 2023. Median SWE were statistically different between groups (no-CP group 1.45m/s; IQR 1.34-1.60 and CP-group 1.7m/s; IQR 1.58-1.89; p<0.0001). Patients with RC criteria indeterminate for CP had significantly lower SWE values compared to patients with RC criteria suggestive/consistent with CP (Median 1.65m/s, IQR 1.50-1.71vs. 1.78m/s, IQR 1.63-1.92, p=0.02). Median USCP Score was significantly different between groups (no CP 0-1 points, with CP 2-6 points, p<0.0001). SWE values were not correlated with age, BMI, HbA1c or stool elastase levels, but correlated significantly with USCP score (p=0.002) and RC (p=0.0001). USCP Score significantly correlated with BMI (p=0.011), stool elastase levels (p=0.002), HbA1c (p=0.002) as well as RC (p<0.0001). A cut off SWE value of<1.4m/s was found to rule out chronic pancreatitis with a sensitivity of 97.6% (specificity 56%) and a SWE cut off>1.6ms/s to diagnose chronic pancreatitis with a sensitivity of 85.3% (specificity 80%).

Conclusions Transabdominal ultrasound evaluation of the pancreas with 2D SWE is a promising, widely applicable and unexpensive tool for the diagnosis of chronic pancreatitis. More studies with larger cohorts confirming the results are necessary.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024