Insulinoma ultrasound: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Insulinoma}} | {{Insulinoma}} | ||
{{CMG}}{{AE}}{{ | {{CMG}}; {{AE}} {{ADS}} | ||
==Overview== | ==Overview== | ||
==Ultrasound== | Transabdominal [[ultrasound]] has low [[sensitivity]] varying between 0 to 66% in detecting insulinoma. The [[sensitivity]] increases with the use of more invasive technique including [[endoscopic ultrasound]] (93%) and intra-operative [[ultrasound]] (86%). Hypo-echoic lesions and hypervascular mass are seen on the [[ultrasound]]. | ||
* | |||
*Endoscopic ultrasound can be | == Transabdominal Ultrasound== | ||
*[[Ultrasound]] may be helpful in the diagnosis of [[insulinoma]]. The [[sensitivity]] varies from 0 to 66%. Smaller [[tumor|tumors]] are difficult to detect especially those on the tail of the pancreas. Findings on a trans-abdominal [[ultrasound]] suggestive of insulinoma include:<ref name="McAuleyDelaney2005">{{cite journal|last1=McAuley|first1=G.|last2=Delaney|first2=H.|last3=Colville|first3=J.|last4=Lyburn|first4=I.|last5=Worsley|first5=D.|last6=Govender|first6=P.|last7=Torreggiani|first7=W.C.|title=Multimodality preoperative imaging of pancreatic insulinomas|journal=Clinical Radiology|volume=60|issue=10|year=2005|pages=1039–1050|issn=00099260|doi=10.1016/j.crad.2005.06.005}}</ref> | |||
** Low [[echogenicity]] | |||
** Hypervascularity on the [[Doppler ultrasound|doppler]] | |||
*An [[ultrasound]] may be helpful in the diagnosis of complications of [[malignant]] insulinoma, which include: | |||
**[[Liver]] [[metastasis]] | |||
==Invasive Ultrasound== | |||
===Endoscopic Ultrasound=== | |||
This is an invasive [[ultrasound]] which can be done pre-operatively. The use has been increased with the increase in [[Sensitivity (tests)|sensitivities]] from 40 to 93%, more accurate in diagnosing [[pancreatic]] head insulinomas. It is supported as the primary diagnostic modality for the diagnosis of [[pancreatic]] [[neuroendocrine tumors]] (which includes insulinoma). The advantages include:<ref name="McAuleyDelaney2005">{{cite journal|last1=McAuley|first1=G.|last2=Delaney|first2=H.|last3=Colville|first3=J.|last4=Lyburn|first4=I.|last5=Worsley|first5=D.|last6=Govender|first6=P.|last7=Torreggiani|first7=W.C.|title=Multimodality preoperative imaging of pancreatic insulinomas|journal=Clinical Radiology|volume=60|issue=10|year=2005|pages=1039–1050|issn=00099260|doi=10.1016/j.crad.2005.06.005}}</ref><ref name="pmid17906369">{{cite journal| author=Sotoudehmanesh R, Hedayat A, Shirazian N, Shahraeeni S, Ainechi S, Zeinali F et al.| title=Endoscopic ultrasonography (EUS) in the localization of insulinoma. | journal=Endocrine | year= 2007 | volume= 31 | issue= 3 | pages= 238-41 | pmid=17906369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17906369 }} </ref><ref name="pmid11007228">{{cite journal| author=Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM| title=Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. | journal=Am J Gastroenterol | year= 2000 | volume= 95 | issue= 9 | pages= 2271-7 | pmid=11007228 | doi=10.1111/j.1572-0241.2000.02480.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11007228 }} </ref> | |||
* Visualization of smaller [[tumors]] (2mm) | |||
* Detection of invasion and local [[metastasis]] | |||
* Higher spatial resolutions | |||
The disadvantages are: | |||
*Invasiveness | |||
*High cost | |||
*Availabilty and expertise | |||
{{#ev:youtube|TF1phjhRZLg}} | |||
== References == | ===Intra-operative Ultrasound=== | ||
The use was introduced in 1981 and used to localize non-palpable lesions and tumors which are in close proximity to [[pancreatic]] and [[bile ducts]]. They can localize the [[tumors]] in 86% of cases when performed during an open or [[laparoscopic surgery]]. <ref name="pmid9426437">{{cite journal| author=Brown CK, Bartlett DL, Doppman JL, Gorden P, Libutti SK, Fraker DL et al.| title=Intraarterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomas. | journal=Surgery | year= 1997 | volume= 122 | issue= 6 | pages= 1189-93; discussion 1193-4 | pmid=9426437 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9426437 }} </ref><ref name="pmid16360384">{{cite journal| author=Grover AC, Skarulis M, Alexander HR, Pingpank JF, Javor ED, Chang R et al.| title=A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas. | journal=Surgery | year= 2005 | volume= 138 | issue= 6 | pages= 1003-8; discussion 1008 | pmid=16360384 | doi=10.1016/j.surg.2005.09.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16360384 }} </ref> | |||
==References== | |||
{{Reflist|2}} | {{Reflist|2}} | ||
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Latest revision as of 15:36, 5 December 2017
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American Roentgen Ray Society Images of Insulinoma ultrasound |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Transabdominal ultrasound has low sensitivity varying between 0 to 66% in detecting insulinoma. The sensitivity increases with the use of more invasive technique including endoscopic ultrasound (93%) and intra-operative ultrasound (86%). Hypo-echoic lesions and hypervascular mass are seen on the ultrasound.
Transabdominal Ultrasound
- Ultrasound may be helpful in the diagnosis of insulinoma. The sensitivity varies from 0 to 66%. Smaller tumors are difficult to detect especially those on the tail of the pancreas. Findings on a trans-abdominal ultrasound suggestive of insulinoma include:[1]
- Low echogenicity
- Hypervascularity on the doppler
- An ultrasound may be helpful in the diagnosis of complications of malignant insulinoma, which include:
Invasive Ultrasound
Endoscopic Ultrasound
This is an invasive ultrasound which can be done pre-operatively. The use has been increased with the increase in sensitivities from 40 to 93%, more accurate in diagnosing pancreatic head insulinomas. It is supported as the primary diagnostic modality for the diagnosis of pancreatic neuroendocrine tumors (which includes insulinoma). The advantages include:[1][2][3]
- Visualization of smaller tumors (2mm)
- Detection of invasion and local metastasis
- Higher spatial resolutions
The disadvantages are:
- Invasiveness
- High cost
- Availabilty and expertise
{{#ev:youtube|TF1phjhRZLg}}
Intra-operative Ultrasound
The use was introduced in 1981 and used to localize non-palpable lesions and tumors which are in close proximity to pancreatic and bile ducts. They can localize the tumors in 86% of cases when performed during an open or laparoscopic surgery. [4][5]
References
- ↑ 1.0 1.1 McAuley, G.; Delaney, H.; Colville, J.; Lyburn, I.; Worsley, D.; Govender, P.; Torreggiani, W.C. (2005). "Multimodality preoperative imaging of pancreatic insulinomas". Clinical Radiology. 60 (10): 1039–1050. doi:10.1016/j.crad.2005.06.005. ISSN 0009-9260.
- ↑ Sotoudehmanesh R, Hedayat A, Shirazian N, Shahraeeni S, Ainechi S, Zeinali F; et al. (2007). "Endoscopic ultrasonography (EUS) in the localization of insulinoma". Endocrine. 31 (3): 238–41. PMID 17906369.
- ↑ Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM (2000). "Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas". Am J Gastroenterol. 95 (9): 2271–7. doi:10.1111/j.1572-0241.2000.02480.x. PMID 11007228.
- ↑ Brown CK, Bartlett DL, Doppman JL, Gorden P, Libutti SK, Fraker DL; et al. (1997). "Intraarterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomas". Surgery. 122 (6): 1189–93, discussion 1193-4. PMID 9426437.
- ↑ Grover AC, Skarulis M, Alexander HR, Pingpank JF, Javor ED, Chang R; et al. (2005). "A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas". Surgery. 138 (6): 1003–8, discussion 1008. doi:10.1016/j.surg.2005.09.017. PMID 16360384.