Abstract
Ultrasound elastography is a relatively new diagnostic technique for measuring the elasticity (hardness) of tissue. Eleven years have passed since the debut of elastography. Various elastography devices are currently being marketed by manufacturers under different names. Pancreatic elastography can be used not only with transabdominal ultrasonography but also with endoscopic ultrasonography, but some types of elastography are difficult to perform for the pancreas. These guidelines aim to classify the various types of elastography into two major categories depending on the differences in the physical quantity (strain, shear wave), and to present the evidence for pancreatic elastography and how to use pancreatic elastography in the present day. But the number of reports on ultrasound elastography for the pancreas is still small, and there are no reports on some elastography devices for the pancreas. Therefore, these guidelines do not recommend methods of imaging and analysis by elastography device.
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References
Ophir J, Céspedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13:111–34.
Samani A, Zubovits J, Plewes D. Elastic moduli of normal and pathological human breast tissues: an inversion-technique-based investigation of 169 samples. Phys Med Biol. 2007;52:1565–76.
Krouskop TA, Wheeler TM, Kallel F, et al. The elastic moduli of breast and prostate tissues under compression. Ultrason Imaging. 1998;20:260–74.
Wellman PS, Howe RD, Dalton E, et al. Breast tissue stiffness in compression is correlated to histological diagnosis. Harvard Bio Robotics Laboratory, Technical Report, 1999.
Ueno E, Tohno E, Soeda S, et al. Dynamic tests in real-time breast echography. Ultrasound Med Biol. 1998;14:53–7.
Shiina T, Doyley MM, Bamber JC. Strain imaging using combined RF and envelope autocorrelation processing. In: Proceedings of the 1996 IEEE int ultrasonics symposium.1996; 1331–6. 14.
Yamakawa, M, T Shiina. Strain estimation using the extended combined autocorrelation method. J Jpn J Appl Phys. 2001;40:3872.
Yamakawa M, Nitta N, Shiina T, et al. High-speed freehand tissue elasticity imaging for breast diagnosis. Jpn J Appl Phys. 2003;42:3265–70.
Shiina T, Yamakawa M, Nitta N, Ueno E. Recent prognosis of ultrasound elasticity imaging technology. Int Congr Ser. 2004;1274:59–63.
Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–50.
Nakashima K, Shiina T, Sakurai M, et al. JSUM ultrasound elastography practice guidelines: breast. J Med Ultrasonics. 2013;40:359–91.
Tsutsumi M, Miyagawa T, Matsumura T, et al. The impact of real-time tissue elasticity imaging (elastography) on the detection of prostate cancer: clinicopathological analysis. Int J Clin Oncol. 2007;12:250–5.
Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–11.
Kudo M, Shiina T, Moriyasu F, et al. JSUM ultrasound elastography practice guidelines: liver. J Med Ultrasonics. 2013;40:325–57.
Hirooka Y, Itoh A, Hashimoto S, et al. Utility of EUS: elastography in the diagnosis of pancreatic diseases. Gastrointest Endosc. 2005;61:AB282.
Uchida H, Hirooka Y, Itoh A, et al. Utility of elastography in the diagnosis of pancreatic diseases using transabdominal ultrasonography. Gastroenterology. 2005;128:A536–A536.
DeWitt J, McGreevy K, LeBlanc J, et al. EUS-guided Trucut biopsy of suspected nonfocal chronic pancreatitis. Gastrointest Endosc. 2005;62:76–84.
Varadarajulu S, Eltoum I, Tamhane A, et al. Histopathologic correlates of noncalcific chronic pancreatitis by EUS: a prospective tissue characterization study. Gastrointest Endosc. 2007;66:501–9.
Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69:1251–61.
Shimosegawa T, Kataoka K, Kamisawa T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol. 2010;45:584–91.
Shiina T. JSUM ultrasound elastography practice guidelines: basics and terminology. J Med Ultrasonics. 2013;40:309–23.
Uchida H, Hirooka Y, Itoh A, et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas. 2009;38:17–22.
Kawada N, Tanaka S, Uehara H, et al. Feasibility of second-generation transabdominal ultrasound-elastography to evaluate solid pancreatic tumors: preliminary report of 36 cases. Pancreas. 2012;41:978–80.
Itokawa F, Itoi T, Sofuni A, et al. EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses. J Gastroenterol. 2011;46:843–53.
Giovannini M. Endoscopic ultrasound elastography. Pancreatology. 2011;11:34–9.
Iglesias-Garcia J, Larino-Noia J, Abdulkader I, et al. EUS elastography for the characterization of solid pancreatic masses. Gastrointest Endosc. 2009;70:1101–8.
Iglesias-Garcia J, Larino-Noia J, Abdulkader I, et al. Quantitative endoscopic ultrasound elastography: an accurate method for the differentiation of solid pancreatic masses. Gastroenterology. 2010;139:1172–80.
Ueno E, Umemoto T, Bando H, et al. New quantitative method in breast elastography: fat-lesion ratio (FLR). In: Proceedings of the radiological society of North America scientific assembly and annual meeting. 2007; November 25–30, Chicago, IL.
Săftoiu A, Vilmann P, Gorunescu F, et al. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy. 2011;43:596–603.
Li X, Xu W, Shi J, et al. Endoscopic ultrasound elastography for differentiating between pancreatic adenocarcinoma and inflammatory masses: a meta-analysis. World J Gastroenterol. 2013;19:6284–91.
Xu W, Shi J, Li X, et al. Endoscopic ultrasound elastography for differentiation of benign and malignant pancreatic masses: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol. 2013;25:218–24.
Dawwas MF, Taha H, Leeds JS, et al. Diagnostic accuracy of quantitative EUS elastography for discriminating malignant from benign solid pancreatic masses: a prospective, single-center study. Gastrointest Endosc. 2012;76:953–61.
Mei M, Ni J, Liu D, et al. EUS elastography for diagnosis of solid pancreatic masses: a meta-analysis. Gastrointest Endosc. 2013;77:578–89.
Ying L, Lin X, Xie ZL, et al. Clinical utility of endoscopic ultrasound elastography for identification of malignant pancreatic masses: a meta-analysis. J Gastroenterol Hepatol. 2013;28:1434–43.
Pei Q, Zou X, Zhang X, et al. Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: a meta-analysis. Pancreatology. 2012;12:402–8.
Kawada N, Tanaka S, Uehara H, et al. Alteration of strain ratio evaluated by transabdominal ultrasound elastography may predict the efficacy of preoperative chemoradiation performed for pancreatic ductal carcinoma: preliminary results. Hepatogastroenterology. 2014;61:478–81.
Shiina T, Nitta N, Ueno E, et al. Real time tissue elasticity imaging using the combined autocorrelation method. J Med Ultrasonics. 2002;29:119–28.
Mateen MA, Muheet KA, Mohan RJ, et al. Evaluation of ultrasound based acoustic radiation force impulse (ARFI) and eSie touch sonoelastography for diagnosis of inflammatory pancreatic diseases. JOP. 2012;13:36–44.
Dietrich CF, Săftoiu A, Jenssen C. Real time elastography endoscopic ultrasound (RTE-EUS), a comprehensive review. Eur J Radiol. 2014;83:405–14.
Giovannini M, Hookey LC, Bories E, et al. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients. Endoscopy. 2006;38:344–8.
Mayerle J, Simon P, Dickson EJ, et al. The role of EUS guided elastography to diagnose solid pancreatic mass lesions. Pancreas. 2010;39:1334.
Itoh Y, Itoh A, Kawashima H, et al. Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens). J Gastroenterol. 2014;49:1183–92.
Janssen J, Papavassiliou I. Effect of aging and diffuse chronic pancreatitis on pancreas elasticity evaluated using semiquantitative EUS elastography. Ultraschall Med. 2014;35:253–8.
Saftoiu A, Vilman P, Gorunescu F, et al. Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer. Gastrointest Endosc. 2008;68:1086–94.
Săftoiu A, Iordache S, Gheonea DI, et al. Combined contrast-enhanced power Doppler and real-time sonoelastography performed durind EUS, used in the differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc. 2010;72:739–747.
Deprez PH. EUS elastography: is it replacing or supplementing tissue acquisition? Gastrointest Endosc. 2013;77:590–2.
Dietrich CF, Hirche TO, Ott M, Ignee A. Real-time tissue elastography in the diagnosis of autoimmune pancreatitis. Endoscopy. 2009;41:718–20.
Giovannini M, Thomas B, Erwan B, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol. 2009;15:1587–93.
Iglesias-Garcia J, Domínguez-Muñoz JE, Castiñeira-Alvariño M, et al. Quantitative elastography associated with endoscopic ultrasound for the diagnosis of chronic pancreatitis. Endoscopy. 2013;45:781–8.
Hirche TO, Ingee A, Barreiros AP, et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions. Endoscopy. 2008;40:910–7.
Janssen C, Dietrich CF. Endoscopic ultrasound-guided fine-needle aspiration biopsy and trucut biopsy in gastroenterology—an overview. Best Pract Res Clin Gastroenterol. 2009;23:743–59.
Abe Y, Irisawa A, Shibukawa G, et al. Does hyperechoic findings on B-mode EUS reflect fibrous changes in patient with chronic pancreatitis, true of fake? Evaluation using EUS elastography. Gastrointest Endosc. 2013;77:AB424.
Kawada N, Tanaka S, Uehara H, et al. Potential use of point shear wave elastography for the pancreas: a single center prospective study. Eur J Radiol. 2014;83:620–4.
Herman BA, Harris GR. Models and regulatory considerations for transient temperature rise during diagnostic ultrasound pulses. Ultrasound Med Biol. 2002;28:1217–24.
Dalecki D, Raeman CH, Child SZ, et al. The influence of contrast agents on hemorrhage produced by lithotripter fields. Ultrasound Med Biol. 1997;23:1435–9.
Barnett SB, Duck F, Ziskin M. Recommendations on the safe use of ultrasound contrast agents. Ultrasound Med Biol. 2007;33:173–4.
Dalecki Diane, Raeman Carol H, Child Sally Z, Penney David P, Carstensen Edwin L. Remnants of Albunex nucleate acoustic cavitation. Ultrasound Med Biol. 1997;23:1405–12.
Yashima Y, Sasahira N, Isayama H, et al. Acoustic radiation force impulse elastography for noninvasive assessment of chronic pancreatitis. J Gastroenterol. 2012;47:427–32.
Friedrich-Rust M, Schlueter N, Smaczny C, et al. Non-invasive measurement of liver and pancreas fibrosis in patients with cystic fibrosis. J Cyst Fibros. 2013;12:431–9.
D’Onofrio M, Crosara S, Canestrini S, et al. Virtual analysis of pancreatic cystic lesion fluid content by ultrasound acoustic radiation force impulse quantification. J Ultrasound Med. 2013;32:647–51.
Goertz RS, Amann K, Heide R, et al. An abdominal and thyroid status with Acoustic Radiation Force Impulse Elastometry—a feasibility study: acoustic Radiation Force Impulse Elastometry of human organs. Eur J Radiol. 2011;80:e226–30.
Sporea I, Bota S, Peck-Radosavljevic M, et al. Acoustic Radiation Force Impulse elastography for fibrosis evaluation in patients with chronic hepatitis C: an international multicenter study. Eur J Radiol. 2012;81:4112–8.
Tomita Y, Azuma K, Nonaka Y, et al. Pancreatic fatty degeneration and fibrosis as predisposing factors for development of pancreatic ductal adenocarcinoma. Pancreas. 2014 (Epub ahead of print).
Arda K, Ciledag N, Aktas E, et al. Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. AJR Am J Roentgenol. 2011;197:532–6.
Acknowledgments
We express our deep gratitude to those who kindly cooperated with us in the making of this paper and provided us with advice as well as images, including: Dr. Takashi Kumada and Dr. Katsuhiko Otobe (Ogaki Municipal Hospital); Dr. Yoshihiko Tachi, Dr. Tadashi Iida, and Dr. Katsumi Nakano (Komaki Municipal Hospital); Ms. Akiko Tonomura and Ms. Chisato Torisawa (Hitachi Aloka); Mr. Masahiro Saito (Siemens); Mr. Shunichiro Tanigawa (GE); Mr. Masahiko Yano (Toshiba); Ms. Yukako Tsubone and Mr. Hiroyuki Maeda (Olympus); and Mr. Masahiro Kozaki (Philips).
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Human rights statements and informed consent: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
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Hirooka, Y., Kuwahara, T., Irisawa, A. et al. JSUM ultrasound elastography practice guidelines: pancreas. J Med Ultrasonics 42, 151–174 (2015). https://doi.org/10.1007/s10396-014-0571-7
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DOI: https://doi.org/10.1007/s10396-014-0571-7