Insulinoma ultrasound: Difference between revisions

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==Overview==
==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 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==
== Transabdominal Ultrasound==

Revision as of 15:19, 15 September 2017

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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 pancraes tail. Findings on a transabdominal ultrasound suggestive of insulinoma include[1]
  • An ultrasound may be helpful in the diagnosis of complications of malignant insulinoma, which include:

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. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

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