INFLAMMATORY PANCREATIC MASSES - DIFFERENTIATION FROM DUCTAL CARCINOMAS WITH CONTRAST-ENHANCED SONOGRAPHY USING CARBON-DIOXIDE MICROBUBBLES

OBJECTIVE. The aim of this study was to evaluate the clinical efficacy of contrast-enhanced sonography using carbon dioxide microbubbles to differentiate inflammatory pancreatic masses from ductal carcinomas of the pancreas. SUBJECTS AND METHODS. Fifty-five patients, including 35 patients with ductal carcinomas and 20 with inflammatory pancreatic m asses, underwent contrast-enhanced sonography, CT, and digital subtrac tion angiography (DSA). Carbon dioxide microbubbles were prepared by m ixing 10 ml of carbon dioxide and the same amount of 25% soybean oil v igorously. Carbon dioxide microbubbles were injected through an angiog raphic catheter that was placed in the celiac axis. Vascularity of the tumors as determined by those three techniques was interpreted by thr ee physicians who had no knowledge of the pathologic results. RESULTS. Contrast-enhanced sonography was best at revealing tumor vascularity among the three techniques. On contrast-enhanced sonography, 19 (95%) of the 20 inflammatory pancreatic masses were isovascular and 32 (91%) of the 35 ductal carcinomas were hypovascular. In contrast, the isova scularity of inflammatory masses was five (25%) on CT, and two (10%) o n DSA, respectively. The sensitivity and accuracy rate of differentiat ing both diseases on contrast-enhanced sonography were 98% and 95%, re spectively; on CT, they were both 73%; and on DSA they were both 67%. From our results, an isovascular mass is probably an inflammatory mass , whereas a hypovascular mass is most likely a ductal carcinoma on con trast-enhanced sonography. CONCLUSION. Contrast-enhanced sonography ca n help differentiate an inflammatory pancreatic mass from a ductal car cinoma.