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EUS-GUIDED DETECTIVE FLOW IMAGING (DFI), A NOVEL ADVANCED IMAGING TECHNIQUE, FOR THE DIFFERENTIAL DIAGNOSIS OF SOLID PANCREATIC TUMORS

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Introduction

The diagnosis of solid pancreatic tumours (SPT) is a clinical challenge and endoscopic ultrasound (EUS) is an essential tool in this setting. A new EUS-guided advanced imaging technique, detective flow imaging (DFI), has been developed to provide information on microvascularisation and low-velocity blood flow without the need for contrast agents.

Aims & Methods

The aim of our study was to evaluate DFI-EUS findings in SPT and compare them with those of contrast-enhanced harmonic EUS with Sonovue® (CEHEUS).
Methods: Prospective and descriptive study including patients with SPT who underwent EUS evaluation. The procedures were performed with a linear echoendoscope (Fujifilm 740UT) attached to the Arietta-850 ultrasound system. Lesions were graded according to the degree of vascularisation using DFI and CEHEUS. The final diagnosis was based on EUS sampling and long-term clinical and radiological follow-up when histology was not available.

Results

106 patients (mean age 67.9 years [range 24-88 years], 48 males) were finally included. The mean lesion size was 28.4±16.2 mm. 46 (43.4%) tumours were located in the pancreatic head, 35 (33.0%) in the body, 1 (0.9%) in the neck, 19 (17.9%) in the tail and 5 (4.7%) in the uncinate process. 63 (59.4%) patients were diagnosed with adenocarcinoma, 30 (28.4%) with neuroendocrine tumour, 6 (5.6%) with inflammatory mass, 2 (1.9%) with pancreatic squamous cell carcinoma and lipoma, and 1 (1.2%) each with pancreatic necrosis, acinar carcinoma and accessory spleen. The vascular pattern of SPT evaluated by CEHEUS and EUS-DFI was concordant in 98.1% of cases. All adenocarcinomas, pancreatic necrosis and pancreatic squamous cell carcinoma were hypovascular. Inflammatory masses were isovascular. Lipomas, accessory spleen and acinar carcinoma were hypervascular on both CEHEUS and EUS-FI. All 30 neuroendocrine tumours were hypervascular on CEHEUS and 28 (93.3%) on EUS-DFI.

Conclusion

DFI-EUS allows evaluation of the vascularisation pattern of pancreatic tumours with comparable accuracy to CEHEUS but without the need for contrast.

Disclosure

Julio Iglesias-Garcia: Advisor Fujifilm

EUS-GUIDED DETECTIVE FLOW IMAGING (DFI), A NOVEL ADVANCED IMAGING TECHNIQUE, FOR THE DIFFERENTIAL DIAGNOSIS OF SOLID PANCREATIC TUMORS

Julio Iglesias-Garcia 1, Yessica Dominguez-Novoa 1, José Lariño-Noia 2, Xurxo Martinez-Seara 3, J. Enrique Domínguez Muñoz 2

1 University Hospital of Santiago de Compostela, Santiago de Compostela, Spain|||Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain

2 Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain|||University Hospital of Santiago de Compostela, Santiago de Compostela, Spain

3 Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain