使用造影剂检测成像的胰腺导管癌超声造影检查

Contrast-enhanced sonography of pancreatic ductal carcinoma using agent detection imaging.

作者信息

Ichino Naohiro, Horiguchi Yuji, Imai Hideo, Osakabe Keisuke, Nishikawa Tohru, Sugita Yukiko, Utsugi Hideko, Togo Yoko, Sawai Tomoko, Mizoguchi Yoshikazu

机构信息

Department of Clinical Physiology, School of Health Sciences, Fujita Health University, Aichi, Japan.

Department of Gastroenterology, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan.

出版信息

J Med Ultrason (2001). 2006 Mar;33(1):29-35. doi: 10.1007/s10396-005-0058-7.

DOI:10.1007/s10396-005-0058-7

PMID:27277616

Abstract

PURPOSE

The aim of this study was to evaluate the enhancement behavior of pancreatic ductal carcinoma by contrast-enhanced sonography with agent detection imaging (ADI), and to clarify the origin of microbubble signals by comparisons with histological findings of resected specimens.

METHODS

The subjects were 21 patients with resectable pancreatic carcinoma. The final histological diagnosis was tubular adenocarcinoma in 20 cases, and anaplastic carcinoma in one case. Ultrasound examinations were performed using an Acuson Sequoia 512 series system, and the contrast agent (Levovist) was injected intravenously in doses of 7 ml (300 mg/ml). The ADI signals (in the tumor) were recorded continuously for 30 s after an injection of Levovist (vascular image) and then obtained intermittently (30 s time-intervals) until the signal had diminished in pancreatic tissue (perfusion image).

RESULTS

Contrast enhancement of the tumor was observed in 71.4% of subjects on the vascular image and 76.3% of subjects on the perfusion image. Enhancement patterns on the vascular image were classified into three types: VI-1 (linear enhancement), VI-2 (spotty enhancement), and VI-3 (no enhancement). VI-1, VI-2, and VI-3 were seen in 9 (42.8%), 6 (28.6%), and 6 (28.6%) of the 21 cases, respectively. Enhancement patterns on the perfusion image were classified into four types: PI-1 (diffuse uneven enhancement), PI-2 (spotty enhancement), PI-3 (peripheral enhancement), and PI-4 (negative enhancement). The incidence of PI-1, PI-2, PI-3, and PI-4 was 4.8%, 42.9%, 28.6%, and 23.8%, respectively. With respect to resectable cases, these enhancement patterns were compared with histological findings, i.e., the distribution of blood vessels in the tumor, remaining pancreatic tissues in the tumor, differentiation of types of adenocarcinoma, volume of stroma, and invasion types of carcinoma. The enhanced patterns consequently corresponded to either the distribution of the blood vessels or the remaining pancreatic tissues in the tumor.

CONCLUSION

This study indicated that pancreatic ductal carcinoma is frequently enhanced by microbubbles, and the signals seem to originate from fine blood vessels and the remaining pancreatic tissues in the tumor.

摘要

目的

本研究旨在通过造影剂检测成像（ADI）的超声造影评估胰腺导管癌的增强表现，并通过与切除标本的组织学结果比较来阐明微泡信号的来源。

方法

研究对象为21例可切除胰腺癌患者。最终组织学诊断为管状腺癌20例，间变性癌1例。使用Acuson Sequoia 512系列系统进行超声检查，静脉注射造影剂（Levovist），剂量为7 ml（300 mg/ml）。注射Levovist（血管图像）后连续30 s记录肿瘤内的ADI信号，然后间歇性获取（间隔30 s），直至胰腺组织内信号减弱（灌注图像）。

结果

71.4%的研究对象在血管图像上观察到肿瘤造影增强，76.3%的研究对象在灌注图像上观察到增强。血管图像上的增强模式分为三种类型：VI-1（线性增强）、VI-2（点状增强）和VI-3（无增强）。21例病例中，VI-1、VI-2和VI-3分别见于9例（42.8%）、6例（28.6%）和6例（28.6%）。灌注图像上的增强模式分为四种类型：PI-1（弥漫性不均匀增强）、PI-2（点状增强）、PI-3（周边增强）和PI-4（无增强）。PI-1、PI-2、PI-3和PI-4的发生率分别为4.8%、42.9%、28.6%和23.8%。对于可切除病例，将这些增强模式与组织学结果进行比较，即肿瘤内血管分布、肿瘤内残留胰腺组织、腺癌类型分化、间质体积和癌的浸润类型。因此，增强模式与肿瘤内血管分布或残留胰腺组织相对应。