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Evaluation of Contrast Enhancement Patterns in Pancreatic Tumors by Coded Harmonic Sonographic Imaging With a Microbubble Contrast Agent

Division of Hepatobiliary Pancreatic Medical Oncology, National Cancer Center Hospital East, Chiba, Japan.

Address correspondence and reprint requests to Michitaka Nagase, MD, Division of Hepatobiliary Pancreatic Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. E-mail: mnagase{at}east.ncc.go.jp.

Objective. The purpose of the study was to assess patterns of primary pancreatic lesions by contrast-enhanced sonography for differentiating ductal carcinomas from other pancreatic tumors. Methods. One hundred six consecutive patients with pancreatic masses, consisting of 83 ductal carcinomas, 7 endocrine carcinomas, 5 intraductal papillary mucinous tumors, 3 cases of autoimmune-related pancreatitis, 3 solid pseudopapillary tumors, 2 cases of chronic pancreatitis, 1 serous cystadenoma, 1 osteoclastoid giant cell tumor, and 1 follicular lymphoma, were examined by contrast-enhanced sonography with coded harmonic imaging in a phase inversion harmonic technique. The contrast enhancement patterns were assessed, and specimens removed during pancreatectomy were subjected to pathologic examination. Results. Internal tumoral vascularity was detected in 47 (56.6%) of the 83 ductal carcinomas. Vascular image spreading and homogeneous staining throughout the tumors were observed in all endocrine carcinomas. Two of the 5 intraductal papillary mucinous tumors were positive for enhancement effects. Enhancement effects were observed in all 3 cases of autoimmune-related pancreatitis, but the degree varied. There was a significant correlation between the intensity of enhancement effects and the ratio of patent vessels in the tumors (P < .05). Conclusions. Vascularity was detected by contrast-enhanced sonography in only about half of the ductal carcinomas, confirming the difficulty in distinguishing those tumors from other pancreatic tumors. There was a correlation between the patency of the vessels in the tumors and their vascularity.

Key Words: autoimmune-related pancreatitis • contrast-enhanced sonography • coded harmonic imaging • endocrine carcinoma • pancreatic cancer • SH U 508A

Abbreviations: AIP, autoimmune-related pancreatitis • CT, computed tomography • IPMT, intraductal papillary mucinous tumor • MRI, magnetic resonance imaging

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