Resectable Pancreatic Adenocarcinoma Depiction of Tumoral Margins at Contrast-Enhanced Ultrasonography

Objective: To evaluate if contrast-enhanced ultrasonography (CEUS) improves the depiction of tumoral margins of pancreatic adenocarcinoma in relation to tumor enhancement, using pathology as criterion standard. Methods: Two hundred forty-one patients affected by pancreatic ductal adenocarcinoma were investigated at CEUS with a second-generation contrast medium of sulfur-hexafluoride microbubbles. Sixty-seven (27.8%) of 241 tumors were resected. By consensus, 2 radiologists reviewed the CEUS examination results of the 67 tumors judging the enhancement as low (hypovascular lesions, hypoechoic to the adjacent parenchyma) or high (iso- or hypervascular lesions, iso- or hyperechoic to the adjacent parenchyma). The resected tumors were evaluated at pathology for the presence of positive neoplastic (R+) or negative neoplastic (R-) resected margins. Results: Of the 67 resected tumors, 35 (52.3%) were R-, whereas 32 (47.7%) were R+. Moreover, at CEUS, of the 67 resected tumors, 43 (64.1%) were hypovascular with low enhancement and 24 (35.8%) were iso-hypervascular with high enhancement. In the R- group, 27 (77.1%) of 35 tumors were hypovascular. In the R+ group, 16 (50%) of 32 lesions were hypovascular. Conclusions: At CEUS the depiction Of tumoral margins of pancreatic adenocarcinoma is more accurate in low enhancement than in high enhancement. The pattern of enhancement of pancreatic adenocarcinoma influences the depiction of tumoral margins at CEUS.