Jikei University Daisan Hospital, Tokyo 201-8601, Japan.
Endosc Ultrasound. 2014 Apr;3(Suppl 1):S13.
In autoimmune pancreatitis (AIP), veins of various sizes are highly affected by obliterative phlebitis without damage to arteries, in contrast, the involvement of both arteries and veins is observed in the mass of pancreatic cancer. A vascular image without blooming artifact in the pancreas is clearly observed in the directional eFLOW (Prosound α10, Aloca Co., Tokyo, Japan) color mode using contrast-enhanced color-Doppler endoscopic ultrasonography (CC-EUS) despite perfusion of the contrast media.
The aim of this study was to compare the vascular structure of AIP with that of pancreatic cancer using CC-EUS. We evaluated the perfusion image and the vascular image of the mass in AIP patients (11) with an increase in serum IgG4 levels (477.3 ± 314.2 IU/mL) and in pancreatic cancer patients (11) with elevated serum CA19-9 levels (49839.0 ± 80061.6 mg/dl), on CC-EUS. Perfusion images were obtained at 20-30 s after injection of a contrast agent, Sonazoid (GE Healthcare AG, Oslo, Norway), by extended pure harmonic detection mode and were assessed as to homogeneity or heterogeneity (containing partial low echoic areas or multiple spotty low echoic areas) enhancement. The vascular image was assessed in the directional eFLOW color mode despite perfusion of the contrast media (40-50 s after injection of Sonazoid) as to the presence of a dendritic vessel network or only a few feeder vessels. The parameters for imaging were as follows: Mechanical index, 0.22-0.24; transmission frequency, 5.0 MHz; and receiving frequency, 5.0 MHz. The Chi-square test or Fisher's exact test was used for comparison of categorical data of the two groups when appropriate. This study was approved by the institutional review board of Sendai City Medical Center. All subjects gave informed consent.
A homogenous pattern in perfusion imaging was seen in 73% of patients with AIP (8/11) and 55% of those with pancreatic cancer (6/11). The rates were not significantly different between the two groups (P = 0.33). In the other patients with a heterogenous pattern, multiple spotty low echoic areas were seen in 33% (1/3) and 80% (4/5) in each group, respectively. A dendritic vascular pattern in the eFLOW color mode was seen in 82% (9/11) of patients with AIP, but was not seen in any of patients with pancreatic cancer. The other patients with AIP (18%) and all patients with pancreatic cancer showed only a few feeder vessels in the mass on CC-EUS.
The eFLOW color mode using Sonazoid may be useful for evaluating the vascular structure of AIP for differential diagnosis from pancreatic cancer.
在自身免疫性胰腺炎（AIP）中，各种大小的静脉受到阻塞性静脉炎的高度影响，而动脉不受影响，相比之下，胰腺癌肿块中同时累及动脉和静脉。尽管对比剂灌注，使用对比增强彩色多普勒内镜超声（CC-EUS）的定向 eFLOW（Prosound α10，Aloca Co.，东京，日本）彩色模式可以清晰地观察到胰腺中无blooming 伪影的血管图像。
本研究旨在使用 CC-EUS 比较 AIP 和胰腺癌的血管结构。我们评估了血清 IgG4 水平升高（477.3±314.2 IU/mL）的 AIP 患者（11 例）和血清 CA19-9 水平升高（49839.0±80061.6 mg/dl）的胰腺癌患者（11 例）的 CC-EUS 上肿块的灌注图像和血管图像。在注射造影剂 Sonazoid（GE Healthcare AG，奥斯陆，挪威）后 20-30 秒，通过扩展纯谐波检测模式获得灌注图像，并评估均匀性或异质性（包含部分低回声区或多个点状低回声区）增强。尽管在注射 Sonazoid 后 40-50 秒对比剂灌注，使用定向 eFLOW 彩色模式评估血管图像是否存在树突状血管网络或仅少数供血血管。成像参数如下：机械指数，0.22-0.24；发射频率，5.0 MHz；接收频率，5.0 MHz。当适当的时候，使用卡方检验或 Fisher 确切概率法比较两组的分类数据。本研究得到了仙台市医疗中心机构审查委员会的批准。所有受试者均签署了知情同意书。
AIP 患者中有 73%（8/11）的灌注成像呈均匀模式，胰腺癌患者中有 55%（6/11）呈均匀模式。两组之间的发生率无显著差异（P=0.33）。在其余呈异质性模式的患者中，每组分别有 33%（1/3）和 80%（4/5）的患者存在多个点状低回声区。AIP 患者中有 82%（9/11）在 eFLOW 彩色模式下可见树突状血管模式，但在胰腺癌患者中未见。AIP 的其他患者（18%）和所有胰腺癌患者在 CC-EUS 上的肿块中仅显示少数供血血管。
使用 Sonazoid 的 eFLOW 彩色模式可能有助于评估 AIP 的血管结构，以便与胰腺癌进行鉴别诊断。
