| Theme |
Diagnostic and Interventional EUS -- Present Status and Future Perspectives |
| Title |
Contrast-enhanced Harmonic EUS for Diagnosis of Digestive Diseases |
| Author |
Ken Kamata |
Department of Gastroenterology and Hepatology, Kinki University School of Medicine |
| Author |
Masayuki Kitano |
Department of Gastroenterology and Hepatology, Kinki University School of Medicine |
| Author |
Masatoshi Kudo |
Department of Gastroenterology and Hepatology, Kinki University School of Medicine |
| [ Summary ] |
The second generation ultrasound contrast agent, Sonazoid® can be oscillated by lower acoustic power levels. It is suitable for EUS because the smaller transducers employed with EUS produce limited acoustic energy. Based on the intensity of enhancement possible in pancreatic solid lesions, as shown by contrast-enhanced harmonic EUS (CH-EUS), they may be classified into four categories：avascular, hypovascular, isovascular and hypervascular lesions. CH-EUS depicts pancreatic ductal carcinomas as hypovascular nodules. In contrast, CH-EUS depicts most neuroendocrine tumors as a having hypervascular patterns. The internal structures of pancreatic cystic tumors, may be clarified with CH-EUS, making it possible to distinguish mural nodules from mucus clots in investigation of intraductal papillary mucinous neoplasms. CH-EUS is also used for evaluation of vascularity in organs other than the pancreas. Heterogeneous enhancement with CH-EUS displays features of malignant lymph nodes. When CH-EUS is used for assessment of the tumor vascularity of gastrointestinal stromal tumors (GISTs) CH-EUS can be used to identify irregular vessels in GISTs with high-grade malignancy. |