Ancillary Diagnostic Techniques in EUS
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Endoscopic ultrasound is very accurate for the diagnosis of several biliopancreatic diseases. In recent years, its accuracy has been improved by the introduction of ancillary diagnostic techniques such as real-time elastography, contrast enhancement, and confocal endomicroscopy.
Qualitative elastography is a diagnostic imaging technique based on the measurement of tissue elasticity (hardness); as such, it may play a role in the diagnosis and management of biliopancreatic diseases since stiff (blue) lesions tend to correspond to malignancy. Semi-quantitative techniques such as strain ratio and hue histogram are also used mainly for research purpose.
Contrast-enhanced endoscopic ultrasound is based either on power Doppler or on a dedicated tissue harmonic. The introduction of contrast-enhanced harmonic endoscopic ultrasound has further improved the characterisation of pancreatic lesions thanks to the accurate study of vascularisation. Different patterns of vascularisation identify different diagnosis.
Confocal laser endomicroscopy is a contrast-based method, which enables in vivo microscopic imaging during EUS as it allows the visualisation of mucosal layer at a subcellular level of resolution. In other words, it provides in vivo histological images or “virtual biopsies”.
KeywordsEndoscopic ultrasound Elastography Contrast enhancement Ultrasound contrast agents
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