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==Overview==
==Overview==


There are no echocardiography/ultrasound findings associated with [disease name].
Transabdominal [[ultrasound]] has low [[sensitivity]] varying between 0 to 66% in detecting insulinoma. The [[sensitivity]] increases with the use of more invasive technique including [[endoscopic ultrasound]] (93%) and intra-operative [[ultrasound]] (86%). Hypo-echoic lesions and hypervascular mass are seen on the [[ultrasound]].


OR
== Transabdominal Ultrasound==


Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[Ultrasound]] may be helpful in the diagnosis of [[insulinoma]]. The [[sensitivity]] varies from 0 to 66%. Smaller [[tumor|tumors]] are difficult to detect especially those on the tail of the pancreas. Findings on a trans-abdominal [[ultrasound]] suggestive of insulinoma include:<ref name="McAuleyDelaney2005">{{cite journal|last1=McAuley|first1=G.|last2=Delaney|first2=H.|last3=Colville|first3=J.|last4=Lyburn|first4=I.|last5=Worsley|first5=D.|last6=Govender|first6=P.|last7=Torreggiani|first7=W.C.|title=Multimodality preoperative imaging of pancreatic insulinomas|journal=Clinical Radiology|volume=60|issue=10|year=2005|pages=1039–1050|issn=00099260|doi=10.1016/j.crad.2005.06.005}}</ref>
** Low [[echogenicity]]
** Hypervascularity on the [[Doppler ultrasound|doppler]]


OR
*An [[ultrasound]]  may be helpful in the diagnosis of complications of [[malignant]] insulinoma, which include:
**[[Liver]] [[metastasis]]


There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
==Invasive Ultrasound==
===Endoscopic Ultrasound===
This is an invasive [[ultrasound]] which can be done pre-operatively. The use has been increased with the increase in [[Sensitivity (tests)|sensitivities]] from 40 to 93%, more accurate in diagnosing [[pancreatic]] head insulinomas. It is supported as the primary diagnostic modality for the diagnosis of [[pancreatic]] [[neuroendocrine tumors]] (which includes insulinoma). The advantages include:<ref name="McAuleyDelaney2005">{{cite journal|last1=McAuley|first1=G.|last2=Delaney|first2=H.|last3=Colville|first3=J.|last4=Lyburn|first4=I.|last5=Worsley|first5=D.|last6=Govender|first6=P.|last7=Torreggiani|first7=W.C.|title=Multimodality preoperative imaging of pancreatic insulinomas|journal=Clinical Radiology|volume=60|issue=10|year=2005|pages=1039–1050|issn=00099260|doi=10.1016/j.crad.2005.06.005}}</ref><ref name="pmid17906369">{{cite journal| author=Sotoudehmanesh R, Hedayat A, Shirazian N, Shahraeeni S, Ainechi S, Zeinali F et al.| title=Endoscopic ultrasonography (EUS) in the localization of insulinoma. | journal=Endocrine | year= 2007 | volume= 31 | issue= 3 | pages= 238-41 | pmid=17906369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17906369  }} </ref><ref name="pmid11007228">{{cite journal| author=Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM| title=Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. | journal=Am J Gastroenterol | year= 2000 | volume= 95 | issue= 9 | pages= 2271-7 | pmid=11007228 | doi=10.1111/j.1572-0241.2000.02480.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11007228  }} </ref>
* Visualization of smaller [[tumors]] (2mm)
* Detection of invasion and local [[metastasis]]
* Higher spatial resolutions
The disadvantages are:
*Invasiveness
*High cost
*Availabilty and expertise


==Ultrasound==
{{#ev:youtube|TF1phjhRZLg}}


*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<ref name="McAuleyDelaney2005">{{cite journal|last1=McAuley|first1=G.|last2=Delaney|first2=H.|last3=Colville|first3=J.|last4=Lyburn|first4=I.|last5=Worsley|first5=D.|last6=Govender|first6=P.|last7=Torreggiani|first7=W.C.|title=Multimodality preoperative imaging of pancreatic insulinomas|journal=Clinical Radiology|volume=60|issue=10|year=2005|pages=1039–1050|issn=00099260|doi=10.1016/j.crad.2005.06.005}}</ref>
===Intra-operative Ultrasound===
:
The use was introduced in 1981 and used to localize non-palpable lesions and tumors which are in close proximity to [[pancreatic]] and [[bile ducts]]. They can localize the [[tumors]] in 86% of cases when performed during an open or [[laparoscopic surgery]]. <ref name="pmid9426437">{{cite journal| author=Brown CK, Bartlett DL, Doppman JL, Gorden P, Libutti SK, Fraker DL et al.| title=Intraarterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomas. | journal=Surgery | year= 1997 | volume= 122 | issue= 6 | pages= 1189-93; discussion 1193-4 | pmid=9426437 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9426437  }} </ref><ref name="pmid16360384">{{cite journal| author=Grover AC, Skarulis M, Alexander HR, Pingpank JF, Javor ED, Chang R et al.| title=A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas. | journal=Surgery | year= 2005 | volume= 138 | issue= 6 | pages= 1003-8; discussion 1008 | pmid=16360384 | doi=10.1016/j.surg.2005.09.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16360384 }} </ref>
** Low [[echogenicity]]
** Hypervascularity on the [[Doppler ultrasound|Doppler]]
 
*An ultrasound  may be helpful in the diagnosis of complications of [[malignant]] insulinoma, which include:
**liver [[metastasis]]
 
==Endoscopic Ultrasound==
This is an invasive ultrasound.   <ref name="McAuleyDelaney2005">{{cite journal|last1=McAuley|first1=G.|last2=Delaney|first2=H.|last3=Colville|first3=J.|last4=Lyburn|first4=I.|last5=Worsley|first5=D.|last6=Govender|first6=P.|last7=Torreggiani|first7=W.C.|title=Multimodality preoperative imaging of pancreatic insulinomas|journal=Clinical Radiology|volume=60|issue=10|year=2005|pages=1039–1050|issn=00099260|doi=10.1016/j.crad.2005.06.005}}</ref>
<ref name="pmid17906369">{{cite journal| author=Sotoudehmanesh R, Hedayat A, Shirazian N, Shahraeeni S, Ainechi S, Zeinali F et al.| title=Endoscopic ultrasonography (EUS) in the localization of insulinoma. | journal=Endocrine | year= 2007 | volume= 31 | issue= 3 | pages= 238-41 | pmid=17906369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17906369 }} </ref>


==References==
==References==
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Latest revision as of 15:36, 5 December 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 to 66% in detecting insulinoma. The sensitivity increases with the use of more invasive technique including endoscopic ultrasound (93%) and intra-operative ultrasound (86%). Hypo-echoic lesions and hypervascular mass are seen on the ultrasound.

Transabdominal Ultrasound

Invasive Ultrasound

Endoscopic Ultrasound

This is an invasive ultrasound which can be done pre-operatively. The use has been increased with the increase in sensitivities from 40 to 93%, more accurate in diagnosing pancreatic head insulinomas. It is supported as the primary diagnostic modality for the diagnosis of pancreatic neuroendocrine tumors (which includes insulinoma). The advantages include:[1][2][3]

  • Visualization of smaller tumors (2mm)
  • Detection of invasion and local metastasis
  • 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 localize non-palpable lesions and tumors which are in close proximity to pancreatic and bile ducts. They can localize the tumors in 86% of cases when performed during an open or laparoscopic 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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