Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors
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초록
Subepithelial tumors are divided into benign subepithelial and potentially malignant gastrointestinal stromal tumors. It is difficultto distinguish between these tumor types. Contrast-enhanced harmonic endoscopic ultrasound is reportedly useful for diagnosingsubepithelial tumors, can be safely and easily performed by understanding the principle and method, and can be used to distinguishbetween tumor types with high sensitivity on the basis of differences in contrast effect. The generated image shows a hyperenhancementpattern in gastrointestinal stromal tumors (sensitivity, 78%–100%; specificity, 60%–100%; accuracy, 60%–100%) and hypoenhancementpattern in benign subepithelial tumors. Contrast-enhanced harmonic endoscopic ultrasound can be used to estimatethe malignancy potential of gastrointestinal stromal tumors by evaluating the uniformity of the contrast and the blood vessels insidethe tumor, with abnormal intra-tumor blood vessels, heterogeneous enhancement, and non-enhancing spots suggesting malignancy. Contrast-enhanced harmonic endoscopic ultrasound has a higher sensitivity than other imaging modalities for the detection ofvascularity within gastrointestinal stromal tumors. Additionally, it has been reported that treatment effects can be estimated byevaluating the blood flow in the gastrointestinal stromal tumor before and after treatment with tyrosine kinase inhibitors using contrastenhancedultrasound. However, there will be subjective-bias and the results depends on the performer’s skill.
Abstract
Subepithelial tumors are divided into benign subepithelial and potentially malignant gastrointestinal stromal tumors. It is difficultto distinguish between these tumor types. Contrast-enhanced harmonic endoscopic ultrasound is reportedly useful for diagnosingsubepithelial tumors, can be safely and easily performed by understanding the principle and method, and can be used to distinguishbetween tumor types with high sensitivity on the basis of differences in contrast effect. The generated image shows a hyperenhancementpattern in gastrointestinal stromal tumors (sensitivity, 78%–100%; specificity, 60%–100%; accuracy, 60%–100%) and hypoenhancementpattern in benign subepithelial tumors. Contrast-enhanced harmonic endoscopic ultrasound can be used to estimatethe malignancy potential of gastrointestinal stromal tumors by evaluating the uniformity of the contrast and the blood vessels insidethe tumor, with abnormal intra-tumor blood vessels, heterogeneous enhancement, and non-enhancing spots suggesting malignancy. Contrast-enhanced harmonic endoscopic ultrasound has a higher sensitivity than other imaging modalities for the detection ofvascularity within gastrointestinal stromal tumors. Additionally, it has been reported that treatment effects can be estimated byevaluating the blood flow in the gastrointestinal stromal tumor before and after treatment with tyrosine kinase inhibitors using contrastenhancedultrasound. However, there will be subjective-bias and the results depends on the performer’s skill.
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