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KEY FACTS
Terminology
Clinical Implications
Role of CEUS
TERMINOLOGY
Definitions
- Pancreatic ductal adenocarcinoma (PDAC): > 80% of solid pancreatic neoplasms
- Origin
- Pancreatic ductal or acinar epithelium
- Outcome
- Poor in most cases
- Curative surgical treatment possible in only ~ 15%
- Poor in most cases
- Clinical presentation
- Abdominal pain, weight loss, and obstructive jaundice
- 85% of PDACs are located within pancreatic head and tend to involve both main pancreatic duct (MPD) &/or common bile duct (CBD) (double duct sign)
- Dilatation of MPD &/or CBD facilitates detection of pancreatic head cancer using US and cross-sectional imaging
- Origin
- Pancreatic neuroendocrine tumor (PNET) and pancreatic neuroendocrine carcinoma (PNEC) are 2nd most common solid neoplastic lesions of pancreas, accounting for < 5% of solid pancreatic neoplasms (with incidence increasing)
- Origin
- Endocrine pancreatic cells
- Classification
- Functioning (hormone producing, less common)
- Nonfunctioning (up to 90% of cases)
- Outcome
- Depends on grade of differentiation
- Excellent in small G1 PNET
- Favorable in PNEC
- Depends on grade of differentiation
- Clinical presentation
- Nonfunctioning PNET: Incidental in majority of patients
- Functioning PNET: Determined by particular symptoms produced by tumor, i.e., hypoglycemia in insulinoma or by metastatic disease
- PNET rarely causes ductal dilatation
- Origin
- Rare pancreatic solid neoplasms
- Metastases
- Renal cell cancer
- Lung cancer
- GI tract cancer
- Lymphoma
- Solid pseudopapillary tumor
- Rare, low-grade malignancy of exocrine pancreas
- Typically presents as large, well-defined, round mass without communication with MPD
- Metastases
- Pancreatic ductal adenocarcinoma (PDAC): > 80% of solid pancreatic neoplasms
CLINICAL IMPLICATIONS
Solid Pancreatic Mass
CEUS TECHNIQUE
Transabdominal CEUS
CE-EUS
IMAGING
Pancreatic Mass Imaging
STAGING AND TREATMENT RESPONSE EVALUATION
Disease Staging
Treatment Response
Selected References
- Li XZ et al: Diagnostic performance of contrast-enhanced ultrasound for pancreatic neoplasms: a systematic review and meta-analysis. Dig Liver Dis. 50(2):132-138, 2018
- Sidhu PS et al: The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version). Ultraschall Med. 39(2):e2-e44, 2018
- Del Prete M et al: Role of contrast-enhanced ultrasound to define prognosis and predict response to biotherapy in pancreatic neuroendocrine tumors. J Endocrinol Invest. 40(12):1373-1380, 2017
- Ran L et al: Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP): a systematic review and a meta-analysis. Medicine (Baltimore). 96(28):e7463, 2017
- Dietrich CF et al: Differential diagnosis of small solid pancreatic lesions. Gastrointest Endosc. 84(6):933-940, 2016
- Lin LZ et al: Contrast-enhanced ultrasound for differential diagnosis of pancreatic mass lesions: a meta-analysis. Med Ultrason. 18(2):163-9, 2016
- Taimr P et al: Liver Contrast-enhanced ultrasound improves detection of liver metastases in patients with pancreatic or periampullary cancer. Ultrasound Med Biol. 41(12):3063-9, 2015
- Vitali F et al: Quantitative perfusion analysis in pancreatic contrast enhanced ultrasound (DCE-US): a promising tool for the differentiation between autoimmune pancreatitis and pancreatic cancer. Z Gastroenterol. 53(10):1175-81, 2015
- D'Onofrio M et al: Diagnostic performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced endoscopic ultrasound (ECEUS) for the differentiation of pancreatic lesions: a systematic review and meta-analysis. Ultraschall Med. 35(6):515-21, 2014
- D'Onofrio M et al: Comparison between CT and CEUS in the diagnosis of pancreatic adenocarcinoma. Ultraschall Med. 34(4):377-81, 2013
- D'Onofrio M et al: Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol. 81(4):630-8, 2012
- Dietrich CF et al: Improved characterisation of solitary solid pancreatic tumours using contrast enhanced transabdominal ultrasound. J Cancer Res Clin Oncol. 134(6):635-43, 2008
- Dörffel Y et al: Neuroendocrine tumors: characterization with contrast-enhanced ultrasonography. Ultraschall Med. 29(5):506-14, 2008
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References
Tables
Tables
KEY FACTS
Terminology
Clinical Implications
Role of CEUS
TERMINOLOGY
Definitions
- Pancreatic ductal adenocarcinoma (PDAC): > 80% of solid pancreatic neoplasms
- Origin
- Pancreatic ductal or acinar epithelium
- Outcome
- Poor in most cases
- Curative surgical treatment possible in only ~ 15%
- Poor in most cases
- Clinical presentation
- Abdominal pain, weight loss, and obstructive jaundice
- 85% of PDACs are located within pancreatic head and tend to involve both main pancreatic duct (MPD) &/or common bile duct (CBD) (double duct sign)
- Dilatation of MPD &/or CBD facilitates detection of pancreatic head cancer using US and cross-sectional imaging
- Origin
- Pancreatic neuroendocrine tumor (PNET) and pancreatic neuroendocrine carcinoma (PNEC) are 2nd most common solid neoplastic lesions of pancreas, accounting for < 5% of solid pancreatic neoplasms (with incidence increasing)
- Origin
- Endocrine pancreatic cells
- Classification
- Functioning (hormone producing, less common)
- Nonfunctioning (up to 90% of cases)
- Outcome
- Depends on grade of differentiation
- Excellent in small G1 PNET
- Favorable in PNEC
- Depends on grade of differentiation
- Clinical presentation
- Nonfunctioning PNET: Incidental in majority of patients
- Functioning PNET: Determined by particular symptoms produced by tumor, i.e., hypoglycemia in insulinoma or by metastatic disease
- PNET rarely causes ductal dilatation
- Origin
- Rare pancreatic solid neoplasms
- Metastases
- Renal cell cancer
- Lung cancer
- GI tract cancer
- Lymphoma
- Solid pseudopapillary tumor
- Rare, low-grade malignancy of exocrine pancreas
- Typically presents as large, well-defined, round mass without communication with MPD
- Metastases
- Pancreatic ductal adenocarcinoma (PDAC): > 80% of solid pancreatic neoplasms
CLINICAL IMPLICATIONS
Solid Pancreatic Mass
CEUS TECHNIQUE
Transabdominal CEUS
CE-EUS
IMAGING
Pancreatic Mass Imaging
STAGING AND TREATMENT RESPONSE EVALUATION
Disease Staging
Treatment Response
Selected References
- Li XZ et al: Diagnostic performance of contrast-enhanced ultrasound for pancreatic neoplasms: a systematic review and meta-analysis. Dig Liver Dis. 50(2):132-138, 2018
- Sidhu PS et al: The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version). Ultraschall Med. 39(2):e2-e44, 2018
- Del Prete M et al: Role of contrast-enhanced ultrasound to define prognosis and predict response to biotherapy in pancreatic neuroendocrine tumors. J Endocrinol Invest. 40(12):1373-1380, 2017
- Ran L et al: Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP): a systematic review and a meta-analysis. Medicine (Baltimore). 96(28):e7463, 2017
- Dietrich CF et al: Differential diagnosis of small solid pancreatic lesions. Gastrointest Endosc. 84(6):933-940, 2016
- Lin LZ et al: Contrast-enhanced ultrasound for differential diagnosis of pancreatic mass lesions: a meta-analysis. Med Ultrason. 18(2):163-9, 2016
- Taimr P et al: Liver Contrast-enhanced ultrasound improves detection of liver metastases in patients with pancreatic or periampullary cancer. Ultrasound Med Biol. 41(12):3063-9, 2015
- Vitali F et al: Quantitative perfusion analysis in pancreatic contrast enhanced ultrasound (DCE-US): a promising tool for the differentiation between autoimmune pancreatitis and pancreatic cancer. Z Gastroenterol. 53(10):1175-81, 2015
- D'Onofrio M et al: Diagnostic performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced endoscopic ultrasound (ECEUS) for the differentiation of pancreatic lesions: a systematic review and meta-analysis. Ultraschall Med. 35(6):515-21, 2014
- D'Onofrio M et al: Comparison between CT and CEUS in the diagnosis of pancreatic adenocarcinoma. Ultraschall Med. 34(4):377-81, 2013
- D'Onofrio M et al: Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol. 81(4):630-8, 2012
- Dietrich CF et al: Improved characterisation of solitary solid pancreatic tumours using contrast enhanced transabdominal ultrasound. J Cancer Res Clin Oncol. 134(6):635-43, 2008
- Dörffel Y et al: Neuroendocrine tumors: characterization with contrast-enhanced ultrasonography. Ultraschall Med. 29(5):506-14, 2008
