Third Medical Clinic, University of Medicine and Pharmacy 'Iuliu Hatieganu', Cluj-Napoca.
Ultraschall Med. 2010 Dec;31(6):571-6. doi: 10.1055/s-0029-1245833. Epub 2010 Nov 15.
Contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) for the assessment of microcirculation and the delineation of pancreatic tumors in order to characterize and stage them has only recently become available for commercial use, and few reports have been published. The purpose of the study was the qualitative and quantitative digital image analysis of pancreatic adenocarcinomas using conventional endoscopic ultrasonography (EUS) and CEH-EUS and the evaluation of whether contrast medium injection modified adenocarcinoma staging and patient management.
In each of 30 prospectively examined patients with suspected pancreatic solid lesions, CEH-EUS was performed using the same quantity of the contrast agent SonoVue and a low mechanical index (0.3 - 0.4), followed by EUS-FNA. The histology, based on EUS-FNA or surgery and 9 months of follow-up, was: pancreatic adenocarcinoma (n = 15), pseudotumoral chronic pancreatitis (n = 12), neuroendocrine tumor (n = 1), common bile duct tumor (n = 1), lymph node metastases of gastric cancer (n = 1). The quantitative analysis was based on histograms obtained from each CEH-EUS video recording.
CEH-EUS showed a hypoenhanced pattern in 14 cases of adenocarcinoma and in 10 cases of chronic pancreatitis. The index of the contrast uptake ratio was significantly lower in adenocarcinoma than in mass-forming chronic pancreatitis. A cut-off uptake ratio index value of 0.17 for diagnosing adenocarcinoma corresponded to an AUC (CI 95%) of 0.86 (0.67 - 1.00) with a sensitivity of 80%, a specificity of 91.7%, a positive predictive value of 92.8%, and a negative predictive value of 78%. The size of the pancreatic mass was assessed significantly more effectively by CEH-EUS but adenocarcinoma staging was not modified.
The majority of cases of both pancreatic adenocarcinoma and chronic pancreatitis were hypoenhanced and visual discrimination was not possible. This is the first study about CEH-EUS for the quantitative assessment of uptake after contrast injection which has shown that it can aid differentiation between benign and malignant masses but cannot replace EUS-FNA. Neither tumor stage nor therapeutic management have changed after contrast medium injection during CEH-EUS.
对比增强谐波内镜超声检查（CEH-EUS）用于评估微循环并描绘胰腺肿瘤，以对其进行特征描述和分期，这仅在最近才可用于商业用途，且仅有少数报告发表。本研究的目的是使用常规内镜超声（EUS）和 CEH-EUS 对胰腺腺癌进行定性和定量数字图像分析，并评估对比剂注射是否改变了腺癌的分期和患者管理。
在 30 例疑似胰腺实性病变的前瞻性检查患者中，每例均使用相同剂量的造影剂 SonoVue 和低机械指数（0.3-0.4）进行 CEH-EUS，随后进行 EUS-FNA。基于 EUS-FNA 或手术和 9 个月的随访结果，组织学诊断为：胰腺腺癌（n=15）、假性肿瘤性慢性胰腺炎（n=12）、神经内分泌肿瘤（n=1）、胆总管肿瘤（n=1）、胃癌淋巴结转移（n=1）。定量分析基于从每个 CEH-EUS 视频记录中获得的直方图。
CEH-EUS 在 14 例腺癌和 10 例慢性胰腺炎中显示低增强模式。腺癌的对比摄取比值指数明显低于肿块型慢性胰腺炎。诊断腺癌的摄取比值指数截断值为 0.17，其 AUC（95%CI）为 0.86（0.67-1.00），灵敏度为 80%，特异性为 91.7%，阳性预测值为 92.8%，阴性预测值为 78%。CEH-EUS 能更有效地评估胰腺肿块的大小，但不能修改腺癌的分期。
大多数胰腺腺癌和慢性胰腺炎病例均为低增强，无法进行视觉区分。这是第一项关于 CEH-EUS 对注射对比剂后摄取进行定量评估的研究，表明其有助于区分良性和恶性肿块，但不能替代 EUS-FNA。CEH-EUS 中注射对比剂后，肿瘤分期和治疗管理均未改变。
