Table 1.
Descriptive Summary of Individual Studies
| Study | Aim of study | Number of subjects | Gender distribution | Mean age (yr) | Location of lesion | Diameter of lesion | Diagnostic modality | Contrast agent | Diagnostic test performance | Complication |
|---|---|---|---|---|---|---|---|---|---|---|
| Kitano et al. (2008) [15], Japan | Prelim study | Human- 2 | N/A | N/A | N/A | N/A | Imaging mode: extended pure harmonic detection mode | Sonovue (2 mL) | Visualization of 2 GIST with rich vasculature | None |
| Mechanical index: 0.4 | ||||||||||
| Frequency: 6 Hz | ||||||||||
| Kitano et al. (2008) [16], Germany and Japan | Prelim study | Animal (Dog)- 12 Humans- 2 (GIST- 1, pancreatic cancer- 1) | N/A | N/A | N/A | N/A | Imaging mode: extended pure harmonic detection mode | Definity Sonovue (2mL) | Visualization of 1 GIST lesion with rich vasculature | None |
| Mechanical index: 0.35-0.40 | ||||||||||
| Frequency: 7.5 MHz | ||||||||||
| Zhao et al. (2016) [17], China | - Grade malignant potential | Human-18 | 1. Very Low grade and low grade- | 1. Very Low-grade and low-grade-51.5±10.0 | 1. Gastric-18 | 1. Very Low-grade and low-grade-14.6±5.8 mm | Imaging mode: extended pure harmonic detection mode | Sonovue (59 mg/5 mL) | Grade malignant potential: | None |
| M- 6 | 2. Intermediate and high-grade-58.9±14.1 | 2. Intermediate and high-grade-33.4±10.6 mm | Mechanical index: 0.25 | Hyper-enhancement onCEH-EUS: | ||||||
| F- 4 | Frequency: 4.7 MHz | 1. Sensitivity- 75% | ||||||||
| 2. Intermediate and high grade- | 2. Specificity-100% | |||||||||
| M-5 | 3. PPV- 33% | |||||||||
| F-3 | 4.NPV-100% | |||||||||
| Ignee et al. (2017) [18], Romania, China and Germany | - Differentiation of GIST from SMT | Human- 57 | N/A | N/A | 1. Gastric- 39 | N/A | Imaging mode: extended pure harmonic detection mode | Sonovue (4.5 mL) | Differentiation of GIST from SMT: | None |
| 2. Intestine- 17 | hyper-enhancement on CEH-EUS: | |||||||||
| 3. Extra-intestinal- 1 | 1. Sensitivity- 98% | |||||||||
| 2. Specificity-100% | ||||||||||
| 3. PPV-100% | ||||||||||
| 4.NPV-93% | ||||||||||
| 5. Accuracy- 98% | ||||||||||
| Kannengiesser et al. (2012) [19], Germany | - Differentiation of GIST from SMT | Human-17 | M-9 | 69±12.0 | N/A | 1. GIST-25.4±18.6 mm | Imaging mode: extended pure harmonic detection mode | Sonovue (2 mL) | Differentiation of GIST from SMT: | 1. Bleeding- |
| F-8 | 2. Benign lesions-23.8±7.5 mm | Hyper-enhanced lesion-100% accuracy | a) Spontaneous-1 | |||||||
| b) Secondary to biopsy- 5 | ||||||||||
| Sakamoto et al. (2011) [20], Japan | - Grade malignant potential | Human-29 | 1. Low-grade- | 1. Low grade-61.7 | 1. Low-grade-stomach- 11 duodenum- 2 | 1. Low-grade-2.9±2.1 cm (range, 1.1-5) | Imaging mode: extended pure harmonic detection mode | Sonazoid (15 μL/kg) | Grade malignant potential: | 1. Bleeding-a) Secondary to fine needle aspiration-1 |
| - Differentiation of GIST from SMT | M- 6 | 2. High grade-64.5 | 2. High-grade-stomach- 11 duodenum- 5 | |||||||
| F-7 | 2. High-grade-3.2±2.5 cm (range, 2-12.1) | Mechanical index: | abnormal vessel visualization | |||||||
| 2. High-grade- | Frequency: 4.7 MHz | |||||||||
| M- 6 | 1. Sensitivity- 100% | |||||||||
| F-10 | 2. Specificity- 63% | |||||||||
| 3. Accuracy- 83% | ||||||||||
| Fukuta et al. (2005) [21], Japan | - Histologic correlation of perfusion imaging | Human- 0 | M-4 | 64.7 | 1. Gastric- 8 | N/A | Imaging mode: contrast enhanced coded phase inversion harmonic US | Levovist (2-5 g) | Histologic correlation of perfusion imaging: | None |
| - Grade malignant potential | F-9 | 2. Duodenum- 3 | Mechanical index: 0.6-0.8 | Vessel density: | ||||||
| 3. Jejunum-1 | Frequency: 2-4 Hz | 11.0 +/- 1.6/mm2poor versus 26.7 +/- 3.7/mm2 (p<0.0l) | ||||||||
| 4. Ileum-1 | Grade malignant potential: | |||||||||
| NPV-100% | ||||||||||
| PPV- 87.5% | ||||||||||
| Yamashita et al. (2015) [22], Japan | - Histologic correlation of perfusion imaging | Human-13 | M- 6 | 68.2 | 1. Gastric-12 | 3.0 cm (range, 1.3-11) | Imaging mode: extended pure harmonic detection mode | Sonazoid (0.7 mL) | Histologic correlation of perfusion imaging: | None |
| - Grade malignant potential | F-7 | 2. Duodenal-1 | Mechanical index: 0.35 | abnormal perfusion image correlation with histology and VEGF expression (p=0.005) | ||||||
| Frequency: 4.7 MHz | Grade malignant potential: | |||||||||
| NPV-100% | ||||||||||
| PPV- 83.3% (p=0.005) | ||||||||||
| Park et al. (2016) [23], Korea | - Grade malignant potential | Human- 35 | M-18 | 56.9±11.9 | 1. Esophagus- 3 | 32.5±12.5 mm | Imaging mode: extended pure harmonic detection mode | Sonovue (2.4 mL) | Grade malignant potential: | None |
| - Differentiation of GIST from SMT | GIST- 26 | F-17 | 2. Gastric- 26 | Mechanical index: 0.17 | Sensitivity-18.2% | |||||
| 3. Duodenum- 3 | Specificity- 73.3% | |||||||||
| 4. Rectum- 3 | PPV- 33.3% | |||||||||
| NPV- 55.0% | ||||||||||
| Accuracy- 42.9% | ||||||||||
| Differentiation of GIST from S.E.L.: | ||||||||||
| Sensitivity- 23.1% | ||||||||||
| Specificity-100% | ||||||||||
| PPV-100% | ||||||||||
| NPV- 55.0% | ||||||||||
| Accuracy- 50.0% |
N/A, not available; GIST, gastrointestinal stromal tumor; CEH-EUS, contrast enhanced harmonic endoscopic ultrasound; PPV, positive predictive value; NPV, negative predictive value; SMT, submucosal tumor; VEGF, vascular endothelial growth factor; S.E.L, subepithelial lesion.