Imaging diagnosis of autoimmune pancreatitis using endoscopic ultrasonography

自身免疫性胰腺炎 医学 弹性成像 放射科 内镜超声 胰管 胰腺癌 胰腺炎 胰腺 内镜超声检查 病态的 超声波 病理 内科学 癌症 内窥镜检查
作者
Takuya Ishikawa,Hiroki Kawashima,Eizaburo Ohno,Yasuyuki Mizutani,Mitsuhiro Fujishiro
出处
期刊:Journal of Medical Ultrasonics [Springer Nature]
卷期号:48 (4): 543-553 被引量:9
标识
DOI:10.1007/s10396-021-01143-w
摘要

The diagnosis of autoimmune pancreatitis (AIP) is challenging and should be achieved through the comprehensive evaluation of clinical, radiological, serological, and pathological evidence, as there is currently no single reliable diagnostic modality. Endoscopic ultrasonography (EUS) can reveal pancreatic parenchymal and ductal features in much more detail than any other existing imaging modality. In this article, we focused on three applications of EUS, i.e., conventional EUS imaging, EUS elastography (EUS-EG), and contrast-enhanced harmonic EUS (CEH-EUS), for the diagnosis of AIP. Diffuse hypoechoic areas, diffuse enlargement, bile duct wall thickening, and peripancreatic hypoechoic margins on conventional EUS are characteristic features of AIP, and the frequencies of these findings are significantly higher in AIP than in pancreatic cancer (PC). EUS-EG of the pancreatic parenchyma in AIP showed homogenous stiffness and that the elasticity of the pancreas may change after steroid therapy. CEH-EUS revealed focal or diffuse iso-enhancement in most AIP cases and hypo-enhancement in most PC cases. However, some AIP cases show a contrast enhancement pattern similar to that of PC. It should be noted that EUS findings of AIP may differ depending on its stage or disease activity. Differentiation from PC has become an increasingly important issue in the process of diagnosing AIP, and EUS, including elastography and contrast enhancement, could be a promising imaging modality for this purpose.
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