Quantitative Perfusion Analysis and Time Intensity Curve Analysis in Differential Diagnosis of Solid Pancreatic Tumors by Contrast-Enhanced Ultrasound. A Pilot Study

Contrast-enhanced ultrasound began to develop rapidly  in recent years inRussia. Due to the physical properties of contrast agents it is possible to differentiate malignant and benign lesions. However, this method only involves a subjective evaluation of the obtained results. For the objectification of ultrasound with contrast enhancement implemented the function “TIC-analysis” (time intensity curve analysis).  

The aim: to assess the clinical value of the TIC-analysis in the differential diagnosis of adenocarcinoma of the pancreas and chronic pseudotumoral pancreatitis by contrast – enhanced ultrasound.

Materials and methods. In A.V. Vishnevsky Institute of surgery contrast – enhanced ultrasound and TIC-analysis was performed on 23 patients with focal lesions of the pancreas. All patients were operated on, tumors were verified morphologically: adenocarcinoma of the pancreas  in 18 (78%) patients, chronic pseudotumoral pancreatitis – in 5 (22%) patients.

Results. The results about intensity of the tumors obtained by the TIC analysis do not allow to differentiate these pathological processes statistically significant (p > 0.05), which, in all probability, due to the fact that pancreatic  adenocarcinoma and chronic pseudotumoral pancreatitis have similar morphological characteristics in the form of pronounced desmoplastic stromal response and fibrosis-hyalinosis, respectively. The “Time to peak| parameter allowed us to determine statistically significant that pancreatic adenocarcinoma had an early accumulation of contrast agent (average 16 sec) and early washout (from an average of 17 sec); the chronic pseudotumoral pancreatitis had the slow accumulation of contrast agent (average  85 sec) and slow washout (from an average of 86 seconds) (p < 0.05).

Conclusion. The “Time to peak” parameter at ultrasound examination with echocontrast allows statistically significantly differentiate adenocarcinoma of the pancreas  and chronic pseudotumoral pancreatitis.  

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