Subscribe to RSS
DOI: 10.1055/s-0032-1308909
Contrast-enhanced harmonic endoscopic ultrasound
Publication History
Publication Date:
23 April 2012 (online)
![](https://www.thieme-connect.de/media/endoscopy/201206/lookinside/thumbnails/10.1055-s-0032-1308909-1.jpg)
Second-generation intravenous blood-pool ultrasound contrast agents are increasingly used in endoscopic ultrasound (EUS) for characterization of microvascularization, differential diagnosis of benign and malignant focal lesions, and improving staging and guidance of therapeutic procedures. Although initially used as Doppler signal enhancers, second-generation microbubble contrast agents are now used with specific contrast harmonic imaging techniques, which benefit from the highly nonlinear behavior of the microbubbles.
Contrast-specific modes based on multi-pulse technology are used to perform contrast-enhanced harmonic EUS based on a very low mechanical index (0.08 – 0.12). Quantification techniques based on dynamic contrast-enhanced ultrasound have been recommended for perfusion imaging and monitoring of anti-angiogenic treatment, mainly based on time–intensity curve analysis. Most of the clinical applications include the differential diagnosis of focal pancreatic masses, with adenocarcinoma having a distinct hypovascular (hypo-enhanced) appearance compared with neuroendocrine tumors, which are hypervascular (with strong arterial hyper-enhancement). However, pseudotumoral chronic pancreatitis and autoimmune pancreatitis also have an iso- or hypervascular appearance, making the differential diagnosis difficult. Even more promising is the use of dynamic contrast-enhanced harmonic EUS for the longitudinal monitoring of the effects of chemotherapy and/or anti-angiogenic therapy in advanced digestive cancers, which are difficult to examine by conventional cross-sectional imaging techniques.
-
References
- 1 Reddy NK, Ioncică AM, Săftoiu A et al. Contrast-enhanced endoscopic ultrasonography. World J Gastroenterol 2011; 17: 42-48
- 2 Dietrich CF. Contrast-enhanced low mechanical index endoscopic ultrasound (CELMI-EUS). Endoscopy 2009; 41 (Suppl. 02) E43-E44
- 3 Sanchez MVA, Varadarajulu S, Napoleon B. EUS contrast agents: what is available, how do they work, and are they effective?. Gastrointest Endosc 2009; 69: 71-77
- 4 Gauthier TP, Averkiou MA, Leen ELS. Perfusion quantification using dynamic contrast-enhanced ultrasound: the impact of dynamic range and gain on time-intensity curves. Ultrasonics 2011; 51: 102-106
- 5 Piscaglia F, Nolsøe C, Dietrich CF et al. The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 2012; 33: 33-59
- 6 Bhutani MS, Hoffman BJ, van Velse A et al. Contrast-enhanced endoscopic ultrasonography with galactose microparticles: SHU508 A (Levovist). Endoscopy 1997; 29: 635-639
- 7 Dietrich CF, Ignee A, Braden B et al. Improved differentiation of pancreatic tumors using contrast-enhanced endoscopic ultrasound. Clin Gastroenterol Hepatol 2008; 6: 590-597 e1
- 8 Hocke M, Schulze E, Gottschalk P et al. Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer. World J Gastroenterol 2006; 12: 246-250
- 9 Săftoiu A, Iordache SA, Gheonea DI et al. Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc 2010; 72: 739-747
- 10 Ishikawa T, Itoh A, Kawashima H et al. Usefulness of EUS combined with contrast-enhancement in the differential diagnosis of malignant versus benign and preoperative localization of pancreatic endocrine tumors. Gastrointest Endosc 2010; 71: 951-959
- 11 Hocke M, Ignee A, Dietrich CF. Contrast-enhanced endoscopic ultrasound in the diagnosis of autoimmune pancreatitis. Endoscopy 2011; 43: 163-165
- 12 Dietrich CF, Ignee A, Frey H. Contrast-enhanced endoscopic ultrasound with low mechanical index: a new technique. Z Gastroenterol 2005; 43: 1219-1223
- 13 Kitano M, Takagi T, Sakamoto H et al. Dynamic imaging of pancreatic tumors by contrast-enhanced harmonic EUS with long-lasting contrast. Gastrointest Endosc 2009; 67: 141-150
- 14 Fusaroli P, Spada A, Mancino MG et al. Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol 2010; 8: 629-634
- 15 Seicean A, Badea R, Stan-Iuga R et al. Quantitative contrast-enhanced harmonic endoscopic ultrasonography for the discrimination of solid pancreatic masses. Ultraschall Med 2010; 31: 571-576