EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions

Silvia Carrara, Milena Di Leo, Fabio Grizzi, Loredana Correale, Daoud Rahal, Andrea Anderloni, Francesco Auriemma, Alessandro Fugazza, Paoletta Preatoni, Roberta Maselli, Cesare Hassan, Elena Finati, Benedetto Mangiavillano, Alessandro Repici

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and Aims: EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis–based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. Methods: Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. Results: Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P <.001]; wSR, 56.6 vs 15.3 [P <.001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P =.0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ±.01) versus neuroendocrine tumor (D = 2.73 ±.03) and a statistical difference for all 3 channels red, green, and blue (P <.0001). Conclusions: EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.)

Original languageEnglish
Pages (from-to)1464-1473
Number of pages10
JournalGastrointestinal Endoscopy
Volume87
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Elasticity Imaging Techniques
Fractals
Sensitivity and Specificity
Neuroendocrine Tumors
Cell Biology
Histology
Software
Clinical Trials
Technology

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions. / Carrara, Silvia; Di Leo, Milena; Grizzi, Fabio; Correale, Loredana; Rahal, Daoud; Anderloni, Andrea; Auriemma, Francesco; Fugazza, Alessandro; Preatoni, Paoletta; Maselli, Roberta; Hassan, Cesare; Finati, Elena; Mangiavillano, Benedetto; Repici, Alessandro.

In: Gastrointestinal Endoscopy, Vol. 87, No. 6, 01.06.2018, p. 1464-1473.

Research output: Contribution to journalArticle

@article{69f9ac5321b747bf954e57081ecbece5,
title = "EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions",
abstract = "Background and Aims: EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis–based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. Methods: Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. Results: Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68{\%}) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P <.001]; wSR, 56.6 vs 15.3 [P <.001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4{\%}, 78.8{\%}, 89.7{\%}, 76.9{\%}, and 86.7{\%} and 91.3{\%}, 69.7{\%}, 86.5{\%}, 80{\%}, and 85.7{\%}, respectively. Fractal analysis showed a significant statistical difference (P =.0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ±.01) versus neuroendocrine tumor (D = 2.73 ±.03) and a statistical difference for all 3 channels red, green, and blue (P <.0001). Conclusions: EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.)",
author = "Silvia Carrara and {Di Leo}, Milena and Fabio Grizzi and Loredana Correale and Daoud Rahal and Andrea Anderloni and Francesco Auriemma and Alessandro Fugazza and Paoletta Preatoni and Roberta Maselli and Cesare Hassan and Elena Finati and Benedetto Mangiavillano and Alessandro Repici",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/j.gie.2017.12.031",
language = "English",
volume = "87",
pages = "1464--1473",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions

AU - Carrara, Silvia

AU - Di Leo, Milena

AU - Grizzi, Fabio

AU - Correale, Loredana

AU - Rahal, Daoud

AU - Anderloni, Andrea

AU - Auriemma, Francesco

AU - Fugazza, Alessandro

AU - Preatoni, Paoletta

AU - Maselli, Roberta

AU - Hassan, Cesare

AU - Finati, Elena

AU - Mangiavillano, Benedetto

AU - Repici, Alessandro

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background and Aims: EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis–based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. Methods: Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. Results: Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P <.001]; wSR, 56.6 vs 15.3 [P <.001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P =.0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ±.01) versus neuroendocrine tumor (D = 2.73 ±.03) and a statistical difference for all 3 channels red, green, and blue (P <.0001). Conclusions: EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.)

AB - Background and Aims: EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis–based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. Methods: Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. Results: Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P <.001]; wSR, 56.6 vs 15.3 [P <.001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P =.0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ±.01) versus neuroendocrine tumor (D = 2.73 ±.03) and a statistical difference for all 3 channels red, green, and blue (P <.0001). Conclusions: EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.)

UR - http://www.scopus.com/inward/record.url?scp=85042315907&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042315907&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2017.12.031

DO - 10.1016/j.gie.2017.12.031

M3 - Article

C2 - 29329992

AN - SCOPUS:85042315907

VL - 87

SP - 1464

EP - 1473

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 6

ER -