Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2017; 23(17): 3184-3192
Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3184
Comparison of endoscopic ultrasound, computed tomography and magnetic resonance imaging in assessment of detailed structures of pancreatic cystic neoplasms
Chen Du, Ning-Li Chai, En-Qiang Linghu, Hui-Kai Li, Li-Hua Sun, Lei Jiang, Xiang-Dong Wang, Ping Tang, Jing Yang
Chen Du, Ning-Li Chai, En-Qiang Linghu, Hui-Kai Li, Li-Hua Sun, Lei Jiang, Xiang-Dong Wang, Ping Tang, Jing Yang, Department of Gastroenterology and Hepatology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Author contributions: Du C and Chai NL contributed equally to this work; Chai NL and Linghu EQ designed the research; Du C, Chai NL, Linghu EQ, Li HK, Sun LH, Jiang L, Wang XD, Tang P and Yang J performed the research; Du C, Sun LH and Jiang L analyzed the data; Du C wrote the paper; Chai NL and Linghu EQ made critical revision of the article for important intellectual content; Linghu EQ approved the final version of the article.
Supported by Scientific Research Fund of Army of China, No. 14BJZ01.
Institutional review board statement: This study was reviewed and approved by the Committee of Medical Ethics of Chinese People’s Liberation Army General Hospital.
Clinical trial registration statement: The study was registered at http://www.chictr.org.cn/showproj.aspx?proj=10604. The registration identification number is ChiCTR-OOC-15006118.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest in relation to this manuscript.
Data sharing statement: There are no additional data available in relation to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: En-Qiang Linghu, PhD, Department of Gastroenterology and Hepatology, Chinese People’s Liberation Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. linghuenqiang@vip.sina.com
Telephone: +86-10-68182255 Fax: +86-10-55499292
Received: January 5, 2017
Peer-review started: January 5, 2017
First decision: February 9, 2017
Revised: February 20, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: May 7, 2017
Processing time: 121 Days and 10.5 Hours
Abstract
AIM

To evaluate the advantages of endoscopic ultrasound (EUS) in the assessment of detailed structures of pancreatic cystic neoplasms (PCNs) compared to computed tomography (CT) and magnetic resonance imaging (MRI).

METHODS

All patients with indeterminate PCNs underwent CT, MRI, and EUS. The detailed information, including size, number, the presence of a papilla/nodule, the presence of a septum, and the morphology of the pancreatic duct of PCNs were compared among the three imaging modalities. The size of each PCN was determined using the largest diameter measured. A cyst consisting of several small cysts was referred to as a mother-daughter cyst. Disagreement among the three imaging modalities regarding the total number of mother cysts resulted in the assumption that the correct number was the one in which the majority of imaging modalities indicated.

RESULTS

A total of 52 females and 16 males were evaluated. The median size of the cysts was 42.5 mm by EUS, 42.0 mm by CT and 38.0 mm by MRI; there was no significant difference in size as assessed among the three imaging techniques. The diagnostic sensitivity and ability of EUS to classify PCNs were 98.5% (67/68) and 92.6% (63/68), respectively. These percentages were higher than those of CT (73.1%, P < 0.001; 17.1%, P < 0.001) and MRI (81.3%, P = 0.001; 20.3%, P < 0.001). EUS was also able to better assess the number of daughter cysts in mother cysts than CT (P = 0.003); however, there was no significant difference between EUS and MRI in assessing mother-daughter cysts (P = 0.254). The papilla/nodule detection rate by EUS was 35.3% (24/68), much higher than those by CT (5.8%, 3/52) and MRI (6.3%, 4/64). The detection rate of the septum by EUS was 60.3% (41/68), which was higher than those by CT (34.6%, 18/52) and by MRI (46.9%, 30/64); the difference between EUS and CT was significant (P = 0.02). The rate of visualizing the pancreatic duct using EUS was 100%, whereas using CT and MRI it was less than 10%.

CONCLUSION

EUS helps visualize the detailed structures of PCNs and has many advantages over CT and MRI. EUS is valuable in the diagnosis and assessment of PCNs.

Keywords: Endoscopic ultrasound; Detailed structures; Computed tomography; Magnetic resonance imaging; Pancreatic cystic neoplasms

Core tip: This study was designed to evaluate the advantages of endoscopic ultrasound (EUS) in the assessment of the detailed structures of pancreatic cystic neoplasms (PCNs) compared with computed tomography (CT) and MRI. Previous studies showed the advantages of EUS in the diagnosis of PCNs. Multiple published studies compared the diagnostic value of EUS, CT, and MRI in patients with PCNs. However, few studies compared the abilities of the three modalities to evaluate the detailed structures of PCNs. There are many studies about the diagnostic value of imaging modalities in pancreatic cystic lesions (PCLs), and several studies assessed their ability to differentiate PCNs from other PCLs. Several studies compared the abilities of imaging modalities in demonstrating daughter cysts.