Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Tropical Medicine

EUS Elastography (EUS-E) and contrast enhanced EUS (CEEUS) are two recent techniques that allow the non-invasive assessment of pancreatic lesions by adding important additional information that could be used in the diagnosis of these lesions. The aim of the study was to investigate the clinical utility of contrast- enhanced endoscopic ultrasound (CEEUS) and endoscopic ultrasound Elastography (EUS-E) in diagnosis of pancreatic masses. Results: Malignant lesions were larger in size (32.2 ± 10.3), and had greater SR-E- EUS and more hypovascular pattern. The mean strain ratio was 16.4 ± 8.14 for benign and 67.76 ± 72.45 for malignant lesions (P = 0.001). Hypovascular pattern after contrast injection was present in 76 % of malignant and 60 % of benign lesions (P = 0.66). ROC analysis for the mean SR-E-EUS of the region of interest yielded an optimal cutoff of 74.4 with an AUC of 0.91 (95% CI: 0.74-0.98) for the best power distinction for malignancy. It provided a sensitivity and specificity of 75% and 80%, respectively. Conclusion: EUS modified techniques such as EUS-E and CEEUS could distinguish between benign and malignant lesions & improve the identification of the vascular pattern respectively. Thus both techniques could be considered a complementary imaging modality in the characterization of pancreatic tumors

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