By Steffen Rickes, P Malfertheiner
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1a). At echo-enhanced sonography, the lesion is poorly vascularized in most cases (fig. 1b). (2) In contrast to adenocarcinomas, neuroendocrine tumors and metastases of renal cell carcinomas show sharply delineated margins, and Wirsung’s duct is usually not dilated (fig. 2a). A hypervascularization after injection of an echo-enhancer is a characteristic sign of these masses (fig. 2b). (3) In particular, the differential diagnosis of adenocarcinomas and pancreatitis-associated masses is notoriously problematic, since both tumors can appear as low-echo and lobulated lesions with dilatation of Wirsung’s duct.
Echo-enhanced sonography offers more diagnostic criteria than conventional ultrasound alone. Therefore, all sonographic procedures should be combined. In comparison with reported results of ERCP and MRCP , echo-enhanced sonography has a similar accuracy in diagnosing pancreatic carcinoma. With respect to the differentiation of pancreatitis-associated tumors, the sensitivity of echo-enhanced power Doppler sonography seems to be slightly lower, while the specificity is somewhat higher compared to ERCP and MRCP .
However, the diagnostic accuracy of angiography is low because it is impossible to investigate the macroscopic tumor features. Unenhanced power Doppler sonography allows the investigation of the vascularization pattern of tumors by ultrasound as well. For instance, there are good results in the differentiation of hepatocellular carcinomas with this method [13, 29]. In the differential diagnosis of pancreatic masses, no diagnostic advantage of this method was observed in comparison to conventional ultrasound.
Advanced Imaging Modalities by Steffen Rickes, P Malfertheiner