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Abstract: Background and Aim: Chronic pancreatitis (CP) is sometimes diagnosed at the progressed stage. For the early diagnosis of CP, endoscopic ultrasonography (EUS) may be a useful method, but its diagnostic criteria is based on subjective judgment. Shear wave elastography (SW‐EG) using transabdominal ultrasonography, which quantifies tissue elasticity as an absolute value, may be an objective and noninvasive method for the diagnosis of CP. Methods: Eighty‐five patients with known or suspected CP who underwent both EUS and SW‐EG from October 2012 to July 2016 were included in this study. Patients were categorized into four stages using Rosemont classification and into three stages using Japan Pancreas Society clinical diagnostic criteria 2009 that was EUS‐based criteria for the diagnosis of CP. SW‐EG was measured five times in the pancreatic parenchyma, and the median value was defined as the pancreatic elastic modulus (PEM). Results: Pancreatic elastic modulus was significantly positively correlated with Rosemont classification stage (rs = 0.54), Japan Pancreas Society stage (rs = 0.41), and the number of EUS features (rs = 0.47). Area under the receiver operating characteristic curve for the accuracy of SW‐EG (consistent with CP and suggestive of CP vs normal and indeterminate for CP) was 0.77 (sensitivity 77.1%, specificity 64.9%). In a multivariate linear regression analysis including various EUS features related to PEM, hyperechoic foci with shadowing and lobularity with honeycombing were independent features related to PEM. Conclusions: Chronic pancreatitis may be diagnosed noninvasively and objectively using SW‐EG without performing EUS. [ABSTRACT FROM AUTHOR]

Background Pancreatic fistula ( PF) is a major complication following pancreatoduodenectomy ( PD). Pancreatic texture is a risk factor for PF, but its evaluation depends on the subjective judgment. The aim of this study was to investigate whether preoperative endoscopic ultrasonography-elastography ( EUS- EG), which objectively assesses tissue elasticity, predict the development of PF following PD. Methods Fifty-nine patients who underwent EUS- EG before PD and had pancreas parenchyma histologically evaluated were included. Using histogram analysis, mean elasticity ( ME), which represents tissue elasticity and is inversely correlated with pancreatic fibrosis, was calculated. Results Among 59 patients, 19 developed PF (32.2%). The ME in patients with PF was significantly higher than that in patients without PF (85.4 vs. 55.6, P < 0.001). Area under the receiver operating characteristic curve for the accuracy of pancreatic texture and ME for predicting PF were 0.718 and 0.846, respectively. When a ME of 70.0 was used as a cut-off value for predicting PF, the sensitivity and specificity were 84.2% and 80.0%, respectively. In a multivariate logistic regression analysis, only a ME of >70.0 was an independent predictor of PF (odds ratio 10.02, P = 0.008). Conclusions Endoscopic ultrasonography-elastography may be an accurate and objective method for predicting PF following PD. [ABSTRACT FROM AUTHOR]

Evaluation of the pancreatic elastic modulus (PEM) using shear wave elastography (SWE) requires at least 5 measurements to ensure reproducibility. The aim of this study was to evaluate improvement in reproducibility of SWE, using the propagation display method in normal pancreas ([NP] phase 1) and to examine the differences in PEM between NP and chronic pancreatitis (CP), intraductal papillary mucinous neoplasm (IPMN) and autoimmune pancreatitis ([AIP] phase 2). In phase 1, the measurement success rate, median PEM in repeated measurements and appropriate number of SWE measurements were determined in 109 cases with NP. In phase 2, PEM was measured in CP (n = 10), IPMN (n = 31) and AIP (n = 5), using the required number of SWE measurements determined in phase 1. In phase 1, the measurement success rate was 93.9% (92/109 cases). The median PEM for NP was 14.6 kPa and the appropriate number of SWE measurements was at least 3. In phase 2, the median PEMs in CP, IPMN and AIP were 19.6, 18.1 and 17.2 kPa, respectively, with significant differences between NP and CP (p = 0.0133) and between NP and IPMN (p = 0.0436). Use of the propagation display method in SWE improves the reproducibility of measurement of PEM. [ABSTRACT FROM AUTHOR]

Background Ultrasound strain elastography is one of the useful methods for evaluating pancreatic lesions. During aging, several pancreatic parenchymal changes occur that may interfere with the interpretation of the ultrasound images. We studied age-related changes in pancreatic elasticity using transabdominal ultrasound strain elastography in subjects without known pancreatic disease. Methods This study was conducted at Nagoya University Hospital, which is an academic medical center, and included 102 subjects (66 women and 39 men) aged 20–85 years (mean 58.6 ± 17.5) who underwent transabdominal ultrasonography for screening and follow-up for non-pancreatic diseases. Strain elastography of the pancreas was performed, and the results were subjected to quantitative strain histogram analysis. The correlations of age with four elastographic parameters (Mean, Standard deviation, Skewness, and Kurtosis) and other findings, including hyperechoic pancreas, hyperechoic liver, and diabetes, were evaluated. Results There was a significant correlation between increasing age and elastographic parameters such as the Mean ( P = 0.004), Skewness ( P = 0.007), and Kurtosis ( P = 0.03), and these differences became significant after the age of 40. The prevalence of hyperechoic pancreas increased with age ( P < 0.001), and the Means were lower in those with hyperechoic pancreas ( P = 0.004) and a higher body mass index (BMI, P = 0.008). No significant correlations with diabetes, hyperechoic liver, or elastographic parameters were demonstrated. Conclusion Strain elastography demonstrated elastographic changes in the pancreas with aging that included a decreasing Mean and increasing Skewness and Kurtosis after the age of 40. The prevalence of pancreatic hyperechogenicity increased, and the pancreatic hyperechogenicity was significantly negatively correlated with the Mean. [ABSTRACT FROM AUTHOR]