Comparison of IV Contrast-Enhanced Sonography and Histopathology of Pancreatic Cancer
Kenji Takeshima1,
Takashi Kumada2,
Hidenori Toyoda2,
Seiki Kiriyama2,
Makoto Tanikawa2,
Hideo Ichikawa1,
Toshiaki Kawachi1 and
Sadanobu Ogawa1
1 Department of Imaging Diagnosis, Ogaki Municipal Hospital, 4-86 Minaminhokawa,
Ogaki, Gifu 503-8502, Japan.
2 Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa,
Ogaki, Gifu 503-8502, Japan.
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Fig. 1 —Drawing shows patterns of changes on contrast-enhanced
sonography. From top to bottom in far right column: complete hypoechoic
response with hyperechoic spot (n = 1), complete hypoechoic response
with no hyperechoic spot (n = 6), marginal isoechoic response with
hyperechoic spot (n = 9), marginal isoechoic response with no
hyperechoic spot (n = 15), and hyperechoic response (n =3)
(bottom row).
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Fig. 2A —54-year-old man with hyperechoic response and 29 x 29
mm tumor of pancreatic head. Sonograms obtained before (A) and 18
(B), 46 (C), and 60 (D) sec after injection of contrast
agent. Tumor (arrowheads, A) is gradually stained on
contrast-enhanced sonography and becomes slightly hyperechoic compared with
surrounding tissue.
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Fig. 2B —54-year-old man with hyperechoic response and 29 x 29
mm tumor of pancreatic head. Sonograms obtained before (A) and 18
(B), 46 (C), and 60 (D) sec after injection of contrast
agent. Tumor (arrowheads, A) is gradually stained on
contrast-enhanced sonography and becomes slightly hyperechoic compared with
surrounding tissue.
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Fig. 2C —54-year-old man with hyperechoic response and 29 x 29
mm tumor of pancreatic head. Sonograms obtained before (A) and 18
(B), 46 (C), and 60 (D) sec after injection of contrast
agent. Tumor (arrowheads, A) is gradually stained on
contrast-enhanced sonography and becomes slightly hyperechoic compared with
surrounding tissue.
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Fig. 2D —54-year-old man with hyperechoic response and 29 x 29
mm tumor of pancreatic head. Sonograms obtained before (A) and 18
(B), 46 (C), and 60 (D) sec after injection of contrast
agent. Tumor (arrowheads, A) is gradually stained on
contrast-enhanced sonography and becomes slightly hyperechoic compared with
surrounding tissue.
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Fig. 2E —54-year-old man with hyperechoic response and 29 x 29
mm tumor of pancreatic head. Histopathologic image shows papillary
adenocarcinoma with septa and vessel. (H and E, x100)
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Fig. 3A —70-year-old man with complete hypoechoic response and 8
x 7 mm tumor of pancreatic head. Sonograms obtained before (A)
and 12 (B), 16 (C), and 30 (D) sec after injection of
contrast agent. Tumor is clearly depicted on contrast-enhanced sonography as
hypoechoic tumor with high contrast, but reduction of hypoechoic area is not
observed (arrowheads, A and D).
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Fig. 3B —70-year-old man with complete hypoechoic response and 8
x 7 mm tumor of pancreatic head. Sonograms obtained before (A)
and 12 (B), 16 (C), and 30 (D) sec after injection of
contrast agent. Tumor is clearly depicted on contrast-enhanced sonography as
hypoechoic tumor with high contrast, but reduction of hypoechoic area is not
observed (arrowheads, A and D).
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Fig. 3C —70-year-old man with complete hypoechoic response and 8
x 7 mm tumor of pancreatic head. Sonograms obtained before (A)
and 12 (B), 16 (C), and 30 (D) sec after injection of
contrast agent. Tumor is clearly depicted on contrast-enhanced sonography as
hypoechoic tumor with high contrast, but reduction of hypoechoic area is not
observed (arrowheads, A and D).
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Fig. 3D —70-year-old man with complete hypoechoic response and 8
x 7 mm tumor of pancreatic head. Sonograms obtained before (A)
and 12 (B), 16 (C), and 30 (D) sec after injection of
contrast agent. Tumor is clearly depicted on contrast-enhanced sonography as
hypoechoic tumor with high contrast, but reduction of hypoechoic area is not
observed (arrowheads, A and D).
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Fig. 3E —70-year-old man with complete hypoechoic response and 8
x 7 mm tumor of pancreatic head. Histopathologic image shows
well-differentiated ductal adenocarcinoma with distinct margin
(arrowheads). Infiltration of cancerous cells is not observed around
margin. (H and E, x40)
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Fig. 4A —56-year-old man with marginal isoechoic response and 18
x 18 mm tumor of pancreatic head. Sonograms obtained before (A)
and 15 (B), 25 (C), and 45 (D) sec after injection of
contrast agent. Peripheral region of tumor shows mild heterogeneous
enhancement on contrast-enhanced sonography, and hypoechoic area is reduced
(arrowheads, A and D).
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Fig. 4B —56-year-old man with marginal isoechoic response and 18
x 18 mm tumor of pancreatic head. Sonograms obtained before (A)
and 15 (B), 25 (C), and 45 (D) sec after injection of
contrast agent. Peripheral region of tumor shows mild heterogeneous
enhancement on contrast-enhanced sonography, and hypoechoic area is reduced
(arrowheads, A and D).
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Fig. 4C —56-year-old man with marginal isoechoic response and 18
x 18 mm tumor of pancreatic head. Sonograms obtained before (A)
and 15 (B), 25 (C), and 45 (D) sec after injection of
contrast agent. Peripheral region of tumor shows mild heterogeneous
enhancement on contrast-enhanced sonography, and hypoechoic area is reduced
(arrowheads, A and D).
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Fig. 4D —56-year-old man with marginal isoechoic response and 18
x 18 mm tumor of pancreatic head. Sonograms obtained before (A)
and 15 (B), 25 (C), and 45 (D) sec after injection of
contrast agent. Peripheral region of tumor shows mild heterogeneous
enhancement on contrast-enhanced sonography, and hypoechoic area is reduced
(arrowheads, A and D).
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Fig. 4E —56-year-old man with marginal isoechoic response and 18
x 18 mm tumor of pancreatic head. Histopathologic image shows moderately
differentiated ductal adenocarcinoma. Margin of tumor is indistinct, with
marked infiltration of cancerous cells (arrowheads). (H and E,
x200)
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Fig. 5A —67-year-old man with marginal isoechoic response and positive
hyperechoic spots in 29 x 24 mm tumor of pancreatic head. Sonograms
obtained before (A) and 15 (B), 18 (C), and 25 (D)
sec after injection of contrast agent. Peripheral region of tumor shows mild
heterogeneous enhancement and reduction of hypoechoic area on
contrast-enhanced sonography (arrowheads, A and D).
Blood vessels developing in tumor are also depicted (arrowhead,
C).
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Fig. 5B —67-year-old man with marginal isoechoic response and positive
hyperechoic spots in 29 x 24 mm tumor of pancreatic head. Sonograms
obtained before (A) and 15 (B), 18 (C), and 25 (D)
sec after injection of contrast agent. Peripheral region of tumor shows mild
heterogeneous enhancement and reduction of hypoechoic area on
contrast-enhanced sonography (arrowheads, A and D).
Blood vessels developing in tumor are also depicted (arrowhead,
C).
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Fig. 5C —67-year-old man with marginal isoechoic response and positive
hyperechoic spots in 29 x 24 mm tumor of pancreatic head. Sonograms
obtained before (A) and 15 (B), 18 (C), and 25 (D)
sec after injection of contrast agent. Peripheral region of tumor shows mild
heterogeneous enhancement and reduction of hypoechoic area on
contrast-enhanced sonography (arrowheads, A and D).
Blood vessels developing in tumor are also depicted (arrowhead,
C).
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Fig. 5D —67-year-old man with marginal isoechoic response and positive
hyperechoic spots in 29 x 24 mm tumor of pancreatic head. Sonograms
obtained before (A) and 15 (B), 18 (C), and 25 (D)
sec after injection of contrast agent. Peripheral region of tumor shows mild
heterogeneous enhancement and reduction of hypoechoic area on
contrast-enhanced sonography (arrowheads, A and D).
Blood vessels developing in tumor are also depicted (arrowhead,
C).
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Fig. 5E —67-year-old man with marginal isoechoic response and positive
hyperechoic spots in 29 x 24 mm tumor of pancreatic head.
Histopathologic image shows moderately differentiated ductal adenocarcinoma;
margin of tumor is indistinct, with marked infiltration of cancerous cells
(arrowheads). Dilated vessels are observed on enlarged image
(arrow). (H and E, x40)
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Copyright © 2005 by the American Roentgen Ray Society.
