**Author details**

The criteria used for the differential diagnosis of pancreatic masses (standard US, Doppler US

Undetectable tumoral vessels

Rarely detectable

Rarely detectable

Rarely detectable tumor vessels

Undetectable tumor

Rarely detectable chaotic tumor vessels

Rarely detectable tumor vessels in young lesions

Several studies proved the utility of CEUS for the characterization of pancreatic tumors [2, 9, 17, 47–49]. The accuracy for the diagnosis of solid pancreatic lesions varies from 91.7% [2] to

vessels

vessels

vessels

Poorly vascularized tumor

Enhancement according to necrosis and inflammation: hyperenhancement in edematous AP with unenhancement of the

Enhancement according to necrosis and inflammation: Hypoenhancement in CP

Hyperenhancing tumors

Hyperenhancing tumors Arteries accompanying the

Enhancing echoic areas inside the

fibrous septa

Unenhancing walls

cyst

(hypoenhancing) Marginal tumoral vessels

necrotic areas

**Lesion Standard US Power Doppler US CEUS**

and CEUS) are presented in **Table 1**.

Acute pancreatitis Hypoechoic

Neuroendocrine tumors Hypoechoic

Cystadenomas Small cysts (<3 cm)

Cystadenocarcinomas Large size cysts (>5 cm)

Chronic pancreatitis Dilated Wirsung duct

Hypoechoic

Imprecisely delineated Dilated Wirsung duct Vascular invasion Metastases

Imprecisely delineated Necrotic areas Thrombosis

Calcifications

Well delineated Undilated Wirsung duct Rare vascular invasion

Metastases

Fibrous septa

duct Metastases

adjacent bowel

**Table 1.** Differential diagnosis of pancreatic masses [1, 9, 45, 46].

92.9% [17] or 93.8% in other series [48].

Pseudocysts Anechoic, well delineated lesion

Small size calcifications

Undilated Wirsung duct

Echoic areas inside the cyst and septaUndilated Wirsung

Signs of acute/chronic pancreatitis Signs of bleeding/calcifications Accompanying changes of the

Ductal

adenocarcinoma

152 Challenges in Pancreatic Pathology

Roxana Șirli\* and Alina Popescu

\*Address all correspondence to: roxanasirli@gmail.com

Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
