Contrast-enhanced sonography of autoimmune pancreatitis - Comparison with pathologic findings

Objective. We evaluated the vascularity of autoimmune pancreatitis lesions on contrast-enhanced harmonic gray scale sonographic images in comparison with the pathologic findings. Methods. Six patients with autoimmune pancreatitis were examined. All patients held their breath from 20 to 50 seconds after the injection of a contrast agent while the vascularity of the lesion was examined by contrast-enhanced harmonic gray scale sonography (early phase), and lesion enhancement was monitored at about 90 seconds after the injection while the patients held their breath for a few seconds (delayed phase). We then compared the vascularity on the contrast-enhanced harmonic gray scale sonographic images with the pathologic findings (fibrosis and inflammation) in all lesions. The vascularity of 3 of the 6 lesions was also evaluated by contrast-enhanced harmonic gray scale sonography before and after treatment with corticosteroids. Results. The autoimmune pancreatitis lesions exhibited mild (n = 1), moderate (n = 3), or marked (n = 2) enhancement throughout almost the entire lesions in both the early and delayed phases. The grade of lesion vascularity on the contrast-enhanced harmonic gray scale sonographic images correlated with the pathologic grade of inflammation and inversely correlated with the grade of fibrosis associated with autoimmune pancreatitis. The vascularity of all 3 lesions had decreased on the contrast-enhanced harmonic gray scale sonographic images after steroid therapy. Conclusions. Contrast-enhanced harmonic gray scale sonography may be useful for evaluating the vascularity of autoimmune pancreatitis lesions and the therapeutic efficacy of steroid therapy. Key words. autoimmune pancreatitis; contrast-enhanced sonography; pathologic findings.