MULTIMEDIA ARTICLE
JOP. J Pancreas (Online) 2014 May 27; 15(3):274-275.
Novel Tissue Harmonic Imaging Clearly Visualizes a Case of Intraductal Papillary Mucinous Neoplasm with Mural Nodules
Kazuyuki Matsumoto, Akio Katanuma
Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
ABSTRACT
Tissue Harmonic Echo (THE) imaging is a sonographic technique that potentially provides images of higher quality than can conventional B-mode images. Potential advantages of THE imaging include improved resolution, improved signal-to-noise ratio, and reduced artifacts [1, 2]. Recently, a novel THE imaging performed using an EUS system with a monitor/processing unit (EU-ME2 PREMIER PLUS; Olympus Medical Systems, Tokyo, Japan) has been developed. Using this technology, we can obtain two THE mode images, namely, THE-P (penetration) and THE-R (resolution). The THE-P mode is suitable for middle range distance observation because it receives a harmonic signal whose frequency is mainly 7.5 MHz. The THE-R mode is suitable for close distance observation from the probe because it receives a harmonic signal whose frequency mainly ranges from 10 to 12 MHz. Here, we report a case of intraductal papillary mucinous neoplasm (IPMN) with mural nodules which could be clearly detected using this novel THE imaging.
A 73-year-old woman was followed for mixed-type IPMN. The B-mode image showed mural nodules (maximum height: 6 mm) which were visualized in the MPD of the pancreatic head (Figure 1a). Both THE-P (Figure 1b) and THE-R (Figure 1c) modes revealed another nodule (height: 8 mm) which could not be readily detected by the B-mode, and more clearly visualized mural nodules in the MPD than the B-mode (Video1).
A newly developed EUS, particularly THE mode imaging, could provide better lesion detection and characterization, and it may be useful for obtaining definitive EUS diagnosis.
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Figure 1a. A B-mode image clearly showed mural nodules (maximum height: 6 mm) in the MPD of the pancreatic head (arrows); Figure 1b. A THE-P mode image revealed another nodule (height: 8 mm) in the MPD near the papilla (arrows) and more clearly visualized mural nodules in the MPD; Figure 1c. A THE-R mode image revealed another nodule (arrows), similarly to the THE-P mode image. |
Received April 16, 2014- Accepted April 21st, 2014
Key words Diagnostic Imaging; Endosonography; Pancreatic Neoplasms
Conflict of Interest All authors declare no conflict of interests for this article.
Correspondence
Kazuyuki Matsumoto
Center for Gastroenterology
Teine-Keijinkai Hospital, 1-jo
12-chome, Maeda, Teine-ku
Sapporo 006-8555
Japan
Phone: +81.11.681.8111
Fax: +81.11.685.2967
E-mail: matsumotokazuyuki0227@yahoo.co.jp
References
1. Shapiro RS, Wagreich J, Rarsons RB, Stancato-Pasik A, Yeh HC, Lao R. Tissue harmonic imaging sonography: evaluation of image quality compared with conventional sonography. Am J Roentgenol. 1998; 171:1203-1206. [PMID:9798848]
2. Ishikawa H, Hirooka Y, Itoh A, Hashimoto S, Okada N, Itoh T et al. A comparison of image quality between tissue harmonic imaging and fundamental imaging with an electronic radial scanning echoendoscope in the diagnosis of pancreatic diseases. Gastrointest Endosc. 2003; 57:931-936. [PMID:12776049]