Application of dynamic contrast enhanced ultrasound in distinguishing focal-type autoimmune pancreatitis from pancreatic ductal adenocarcinoma

Article type: Research Article

Authors: Qiu, Yi-Jie^a | Zhao, Guo-Chao^{b; 1; *} | Shi, Shuai-Nan^a | Zuo, Dan^{a; c} | Zhang, Qi^a | Dong, Yi^{a; 1; *} | Lou, Wen-Hui^{b; 2; *} | Wang, Wen-Ping^a

Affiliations: [a] Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China | [b] Department of Pancreas Surgery, Zhongshan Hospital, Fudan University, Shanghai, China | [c] Shanghai Institute of Medical Imaging, Shanghai, China

Correspondence: [*] Corresponding authors: Prof. Dr. Yi Dong, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. Tel.: +86 (0)21 64041990 2474; Fax: +86 (0)21-64220319; E-mail: [email protected] and Prof. Wen-Hui Lou, Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University 180 Fenglin Road, Shanghai, 200032, China. Tel.: 86 (0)21 64041990 2474; Fax: 86 (0)21 64220319. E-mail: [email protected].

Note: [1] These author contributed to this work equally as first author.

Note: [2] These authors contributed to this work equally as corresponding authors.

Abstract: OBJECTIVE:To explore the value of dynamic contrast enhanced ultrasound (DCE-US) in preoperative differential diagnosis of focal-type autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS:From May 2016 to March 2020, patients with biopsy and histopathologically confirmed focal-type AIP (n = 9) were retrospectively included. All patients received contrast enhanced ultrasound (CEUS) examinations one week before surgery/biopsy. Dynamic analysis was performed by VueBox® software (Bracco, Italy). Eighteen cases of resection and histopathologically proved PDAC lesions were also included as control group. B mode ultrasound (BMUS) features, CEUS enhancement patterns, time intensity curves (TICs) and CEUS quantitative parameters were obtained and compared between AIP and PDAC lesions. RESULTS:After injection of ultrasound contrast agents, most focal-type AIP lesions displayed hyper-enhancement (2/9, 22.2%) or iso-enhancement (6/9, 66.7%) during arterial phase of CEUS, while most of PDAC lesions showed hypo-enhancement (88.9%) (P < 0.01). During late phase, most of AIP lesions showed iso-enhancement (8/9, 88.9%), while most of PDAC lesions showed hypo-enhancement (94.4%) (P < 0.001). Compared with PDAC lesions, TICs of AIP lesions showed delayed and higher enhancement. Among all CEUS perfusion parameters, ratio of PE (peak enhancement), WiAUC (wash-in area under the curve), WiR (wash-in rate), WiPI (wash-in perfusion index, WiPI = WiAUC/ rise time), WoAUC (wash-out area under the curve), WiWoAUC (wash-in and wash-out area under the curve) and WoR (wash-out rate) between pancreatic lesion and surrounding normal pancreatic tissue were significantly higher in AIP lesions than PDAC lesions (P < 0.05). CONCLUSION:DCE-US with quantitative analysis has the potential to make preoperative differential diagnosis between focal-type AIP and PDAC non-invasively.

Keywords: Dynamic contrast enhanced ultrasound (DCE-US), autoimmune pancreatitis (AIP), time intensity curves (TICs), quantitative parameters, preoperative

DOI: 10.3233/CH-221390

Journal: Clinical Hemorheology and Microcirculation, vol. 81, no. 2, pp. 149-161, 2022