- (2014) Volume 15, Issue 3
Kazuyuki Matsumoto* and Akio Katanuma
Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
Received April 16, 2014- Accepted April 21st, 2014
Tissue Harmonic Echo (THE) imaging is a sonographic technique that potentially provides images of higher quality than can conventional B-mode images. Potential advantages of THE imaging include improved resolution, improved signal-to-noise ratio, and reduced artifacts [1, 2]. Recently, a novel THE imaging performed using an EUS system with a monitor/processing unit (EU-ME2 PREMIER PLUS; Olympus Medical Systems, Tokyo, Japan) has been developed. Using this technology, we can obtain two THE mode images, namely, THE-P (penetration) and THE-R (resolution). The THE-P mode is suitable for middle range distance observation because it receives a harmonic signal whose frequency is mainly 7.5 MHz. The THE-R mode is suitable for close distance observation from the probe because it receives a harmonic signal whose frequency mainly ranges from 10 to 12 MHz. Here, we report a case of intraductal papillary mucinous neoplasm (IPMN) with mural nodules which could be clearly detected using this novel THE imaging.
Endoscopic Ultrasonography; Diagnostic Imaging; Pancreatic Neoplasm
A 73-year-old woman was followed for mixed-type IPMN. The B-mode image showed mural nodules (maximum height: 6 mm) which were visualized in the MPD of the pancreatic head (Figure 1a). Both THE-P (Figure 1b) and THE-R (Figure 1c) modes revealed another nodule (height: 8 mm) which could not be readily detected by the B-mode, and more clearly visualized mural nodules in the MPD than the B-mode (Video1).
Figure 1a. A B-mode image clearly showed mural nodules (maximum height: 6 mm) in the MPD of the pancreatic head (arrows); Figure 1b. A THE-P mode image revealed another nodule (height: 8 mm) in the MPD near the papilla (arrows) and more clearly visualized mural nodules in the MPD; Figure 1c. A THE-R mode image revealed another nodule (arrows), similarly to the THE-P mode image.
Video 1. The B-mode image showed mural nodules which were visualized in the MPD of the pancreatic head. Both THE-P and THE-R modes revealed another nodule which could not be readily detected by the B-mode, and more clearly visualized mural nodules in the MPD than the B-mode.
A newly developed EUS, particularly THE mode imaging, could provide better lesion detection and characterization, and it may be useful for obtaining definitive EUS diagnosis.
All authors declare no conflict of interests for this article.
