Miwa Haruo, Numata Kazushi, Sugimori Kazuya, Kaneko Takashi, Sakamaki Kentaro, Ueda Michio, Fukuda Hiroyuki, Tanaka Katsuaki, Maeda Shin
Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Abdom Imaging. 2014 Oct;39(5):988-99. doi: 10.1007/s00261-014-0135-8.
To investigate the usefulness of contrast-enhanced three-dimensional ultrasonography (CE 3D US) for differential diagnosis of solid pancreatic lesions.
Eighty-five patients with solid pancreatic lesions who underwent CE 3D US were retrospectively analyzed. Sixty-four patients had pancreatic ductal adenocarcinoma (PDAC), 10 had mass-forming pancreatitis (MFP), and 11 had neuroendocrine tumor (NET). Two blinded readers evaluated the enhancement patterns using four features: vascularity in the arterial phase, vascularity in the venous phase, vessel location, and vessel form. Vascularity in both phases was classified as hypervascular, isovascular, or hypovascular. Vessel location was classified into peritumoral or intratumoral. Vessel form was classified into fine or irregular. Kappa values were used to assess inter-reader agreement. The institutional review board approved this study, and informed consent was obtained.
Kappa values of the four features were 0.75, 0.72, 0.85, and 0.65, which were graded as good or excellent. The most typical combined enhancement pattern in PDAC was hypovascularity in both phases with peritumoral and irregular vessels; MFP was isovascular in both phases with intratumoral and fine vessels; and NETs were hypervascular in both phases with intratumoral and irregular vessels. The sensitivity and positive predictive value of the three patterns were 93.8% and 96.7% for the PDAC pattern, 80.0% and 100% for the MFP pattern, and 81.8%, and 69.2% for the NET pattern, respectively. The accuracy of these diagnostic criteria was 90.5%.
CE 3D US allows detailed visualization of the enhancement patterns of various pancreatic lesions and can be used for the differential diagnosis.
探讨对比增强三维超声（CE 3D US）在胰腺实性病变鉴别诊断中的应用价值。
回顾性分析85例接受CE 3D US检查的胰腺实性病变患者。其中64例为胰腺导管腺癌（PDAC），10例为肿块型胰腺炎（MFP），11例为神经内分泌肿瘤（NET）。两名盲法阅片者利用四个特征评估增强模式：动脉期血管分布、静脉期血管分布、血管位置和血管形态。两期血管分布分为高血管、等血管或低血管。血管位置分为瘤周或瘤内。血管形态分为纤细或不规则。kappa值用于评估阅片者间的一致性。本研究获机构审查委员会批准，并获得了知情同意。
四个特征的kappa值分别为0.75、0.72、0.85和0.65，均为良好或优秀等级。PDAC最典型的联合增强模式为两期均为低血管，伴有瘤周和不规则血管；MFP为两期均为等血管，伴有瘤内和纤细血管；NET为两期均为高血管，伴有瘤内和不规则血管。三种模式的敏感性和阳性预测值分别为：PDAC模式93.8%和96.7%，MFP模式80.0%和100%，NET模式81.8%和69.2%。这些诊断标准的准确性为90.5%。
CE 3D US能够详细显示各种胰腺病变的增强模式，可用于鉴别诊断。
