Abstracts S69

frequency. Kruskal-Wallis test was used for statistical analysis of

anatomic location.

Results: The intensity of twinkling artifact on color Doppler sonog-

raphy was significantly greater than that of comet tail artifact on gray-

scale (p , 0.001). Interestingly, the intensity of twinkling artifact on

1.8 MHz Doppler frequency was significantly higher than that on 4.0

MHz Doppler frequency (p , 0.05). Anatomically, the intensity of

comet tail artifact at the posterior wall and segmental adenomyomatosis

of gallbladder body was significantly weaker than at other locations of

the gallbladder (p , 0.05). However, the intensity of CDTA did not

show any significant difference according to the location.

Conclusion: CDTA may be very useful to recognize the gallbladder ad-

enomyomatosis regardless of its anatomic location, which is more prom-

inently seen than comet tail artifacts. In addition, for detection of CDTA,

use of 1.8 MHz Doppler frequency is more recommended than 4.0 MHz

Doppler frequency.

SS 35.03

Role of Contrast-Enhanced Ultrasound Cholangiography after

Percutaneous Biliary Drainage in Patients with Obstructive

Jaundice

Z. A. Sparchez,1 P. Radu,2 M. Tantau,3 R. I. Badea1

1Ultrasound, 3rd Medical Clinic, Cluj Napoca/RO, 23rd Medical Clinic,

Cluj Napoca/RO, 3Endoscopy, 3rd Medical Clinic, Cluj Napoca/RO

Purpose: To assess the utility of CEUS cholangiography performed

through a echo-guided inserted catheter in patients with obstructive

jaundice.

Material & Methods: Thirty patients (18 males, 12 females, mean age

68, range 43-90) with malignant biliary obstruction (17 hilar, 8 middle

common bile duct, 5 distal) in whom endoscopic biliary drainage was

not possible or the inserted stent was occluded were sent for percuta-

neous biliary drainage (PBD). After the insertion of a 7-8 F catheter

into the biliary tree, two drops of SonoVue (Bracco, Italy) were mixed

with 100ml of saline and then injected through the catheter in the biliary

tree. The liver and bile ducts were scanned with harmonic imaging with

a low mechanical index trying to assess the anatomy of the biliary tree,

location of the catheter tip, communication of the left and right biliary

tree, depiction and length of stenosis (in hilar and middle obstructions),

patency of the endoscopically inserted stent and dislodgment of the cath-

eter. The parameters were then compared with those obtained after

a cholangiography through the catheter.

Results: CEUS cholangiography has a sensitivity of 100% in assessing

the location of the catheter tip (30/30), communication of left and right

biliary tree in the case of hilar obstruction (17/17) and dislodgment of

the catheter with intraperitoneal biliary leak (4/4). In all five cases

with previous stenting, CEUS cholangiography was able to demonstrate

the patency of the stent. The depiction and length of stenosis were

possible in only 10 of 25 cases (40% sensitivity).

Conclusion: CEUS cholangiography is a very good technique to assess

the anatomy of the biliary tree . Through the information obtained it can

play an important role after percutaneous biliary drainage and in plan-

ning a subsequent biliary intervention (second PBD or percutaneous

stenting).

SS 35.04

Value of Near-Isovoxel Ultrasound for Determination of

Pancreatic Duct Communication of Pancreatic Cystic Lesions:

Correlation with MRCP

J. Y. Lee, B. I. Choi, J. H. Kim, S. H. Kim, J. K. Han

Radiology, Seoul National University Hospital, Seoul/KR

Purpose: To prospectively assess the value of a near-isovoxel ultra-

sound (US) imaging using matrix array probe technology for the deter-

mination of the presence of pancreatic duct (PD) communication with

pancreatic cystic lesions.

Material & Methods: The institutional review board approved this

study and informed consent was obtained for all patients. Twenty

patients (M:F 5 8:12, mean age 5 61.1 years) underwent B-mode

and near-isovoxel US for their pancreatic cystic lesions (16 intraductal

papillary mucinous neoplasms (IPMN) and 4 serous cystadenomas)

that had been diagnosed on MRCP. An iU 22 Philips US scanner with

a matrix array 3D transducer X6-1 was used for US imaging. All

near-isovoxel US images were reconstructed with multiplanar reforma-

tions (MPR). A radiologist was asked to determine the presence of PD

communication with the lesions on a 5-point confidence scale on B-

mode US, reconstructed near-isovoxel US, and MRCP separately. The

interclass correlation was analyzed.

Results: On MRCP, variable degree of cyst communication with MPD

was noted (10 definite communication, 2 probable communication, 4

possible communication, 3 probable no communication, and 1 definite

no communication). Regarding correlation of confidence score on the

presence of PD communication, near-isovoxel US with MPR provided

better correlation with MRCP findings than B-mode US did.

Conclusion: The near-isovoxel US imaging using matrix probe tech-

nology may be useful for the determination of PD communication

with pancreatic cysts and differentiation between IPMN and non-

IPMN.

SS 35.05

Evaluation of Ultrasound-Based Acoustic Radiation Force

Impulse and eSie Touch Sonoelastography for Diagnosis of

Pancreatic Diseases

A. M. Khan,1 M. A. Mateen,2 G. V. Rao,2 D. Nageshwar Reddy2

1Radiology, Tbilisi StateMedical University, Tbilisi/GE, 2Asian Institute

of Gastro Enterology, Asian Institute of Gastro Enterology,

Hyderabad/IN

Purpose: This study was conducted to prospectively assess the accuracy

of per-abdominal US elastography in the form of ARFI (acoustic radia-

tion force impulse) and eSie Touch elasticity imaging in differentiating

normal pancreas, chronic pancreatitis and acute pancreatitis. Both tech-

niques measure the mechanical stiffness of the tissue.

Material & Methods: The study population consisted of 166 patients,

50 patients with normal pancreas, 116 patients with diagnosed pancre-

atic pathology. Patients were divided into normal, chronic and acute/

acute resolving pancreatitis group. ARFI and eSie Touch elasticity

imaging techniques were applied.

Results: The mean ARFI values were 1.27, 1.25 and 3.3 for normal,

chronic and acute pancreas. The eSie Touch grey and color elastograms

were light grey and purple-greenish for normal and chronic pancreas,

while for acute pancreas, elastograms were dark black and red.

Conclusion: Both techniques could diagnose acute pancreatitis, assess

the extent of infection - focal or diffuse, assess peripancreatic oedema,

identify the presence of necrotic areas and early pseudocyst formation,

early diagnosis of acute recurrent attacks and monitor patients’ response

to treatment. Using these techniques, acute exacerbations and recurrent

attacks in chronic pancreatitic patients may be monitored. Limitations

include the inability to differentiate chronic pancreas from normal.

Further modifications in the above techniques specific to pancreas would

be valuable in diagnosing chronic pancreatitis, considering its high prev-

alence.

SS 35.06

Ultrasound Disgnosis of Rare Cystic Formations of the Pancreas

Y. A. Stepanova

Radiology, A.V. Vishnevsky Institute of Surgery, Moscow/RU