Ancillary Diagnostic Techniques in EUS

  • Anna Cominardi
  • Pietro FusaroliEmail author


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”.


Endoscopic ultrasound Elastography Contrast enhancement Ultrasound contrast agents 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.University of BolognaBolognaItaly

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