Insulinoma ultrasound
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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 0-66% 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 senstivity varies from 0-66%. Smaller tumor are 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 senstivities 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 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 localise non-palpable lesions and those who are in close proximity to pancreatic and bile ducts. They can localise the tumors in 86% of cases when performed during an open or laproscopic 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.