Hypoglycemia echocardiography or ultrasound: Difference between revisions
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{{CMG}} {{AE}} {{MAD}} | {{CMG}} {{AE}} {{MAD}} | ||
==Overview== | ==Overview== | ||
Transabdominal ultrasound has low sensitivity varying between 0-66% in detecting insulinoma. The sensitivity increases with the use of more invasive endoscopic ultrasound (93%) and intraoperative ultrasound (86%).We see hypoechoic lesions and hypervascular mass on the ultrasound. | [[Ultrasound|Transabdominal ultrasound]] has low [[sensitivity]] varying between 0-66% in detecting [[insulinoma]]. The sensitivity increases with the use of more invasive [[endoscopic ultrasound]] (93%) and intraoperative ultrasound (86%).We see hypoechoic lesions and hypervascular mass on the [[ultrasound]]. | ||
== Transabdominal Ultrasound== | == Transabdominal Ultrasound== | ||
*Ultrasound may be helpful in the diagnosis of [[insulinoma]]. The | *Ultrasound may be helpful in the diagnosis of [[insulinoma]]. The sensitivity varies from 0-66%. The smaller tumor is difficult to detect especially those on [[pancreas]] tail. Findings on a transabdominal [[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]] | ** Low [[echogenicity]] | ||
** Hypervascularity on the [[Doppler ultrasound|Doppler]] | ** Hypervascularity on the [[Doppler ultrasound|Doppler]] | ||
*An ultrasound | *An [[ultrasound]] may be helpful in the diagnosis of complications of [[malignant]] [[insulinoma]], which include liver [[metastasis]]. | ||
==Invasive Ultrasound== | ==Invasive Ultrasound== | ||
===Endoscopic Ultrasound=== | ===Endoscopic Ultrasound=== | ||
This is an invasive ultrasound which can be done pre-operatively. The use has been increased with the increase in | This is an invasive [[ultrasound]] which can be done pre-operatively. The use has been increased with the increase in sensitivity from 40-93%, more accurate in pancreatic head [[Insulinoma|insulinomas.]] It is supported as the primary diagnostic modality for the diagnosis of pancreatic [[neuroendocrine tumors]] (which includes [[insulinoma]]).<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> | ||
<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> | |||
* It enables visualization of smaller tumors (2 mm) | The advantages are: | ||
* It enables visualization of smaller [[Tumor|tumors]] (2 mm) | |||
* Local metastasis and invasion can be detected | * Local metastasis and invasion can be detected | ||
* Higher | * Higher resolutions | ||
The disadvantages are | The disadvantages are invasiveness, high cost, availability, and expertise. | ||
{{#ev:youtube|TF1phjhRZLg}} | {{#ev:youtube|TF1phjhRZLg}} | ||
===Intra-operative Ultrasound=== | ===Intra-operative Ultrasound=== | ||
The use was introduced in 1981 and used to | The use was introduced in 1981 and used to localize non-palpable lesions and those who are in close proximity to [[Pancreatic duct|pancreatic]] and [[bile ducts]]. They can localize the tumors in 86% of cases when performed during an open or [[Laparoscopic surgery|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== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 14:29, 22 September 2017
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Risk calculators and risk factors for Hypoglycemia echocardiography or ultrasound |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Transabdominal ultrasound has low sensitivity varying between 0-66% in detecting insulinoma. The sensitivity increases with the use of more invasive endoscopic ultrasound (93%) and intraoperative ultrasound (86%).We see hypoechoic lesions and hypervascular mass on the ultrasound.
Transabdominal Ultrasound
- Ultrasound may be helpful in the diagnosis of insulinoma. The sensitivity varies from 0-66%. The smaller tumor is difficult to detect especially those on pancreas tail. Findings on a transabdominal 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 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 from 40-93%, more accurate in pancreatic head insulinomas. It is supported as the primary diagnostic modality for the diagnosis of pancreatic neuroendocrine tumors (which includes insulinoma).[1][2][3]
The advantages are:
- It enables visualization of smaller tumors (2 mm)
- Local metastasis and invasion can be detected
- Higher resolutions
The disadvantages are invasiveness, high cost, availability, and expertise. {{#ev:youtube|TF1phjhRZLg}}
Intra-operative Ultrasound
The use was introduced in 1981 and used to localize non-palpable lesions and those who 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.