Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
J Gastroenterol Hepatol. 2018 Mar;33(3):756-761. doi: 10.1111/jgh.13926.
Chronic pancreatitis (CP) is sometimes diagnosed at the progressed stage. For the early diagnosis of CP, endoscopic ultrasonography (EUS) may be a useful method, but its diagnostic criteria is based on subjective judgment. Shear wave elastography (SW-EG) using transabdominal ultrasonography, which quantifies tissue elasticity as an absolute value, may be an objective and noninvasive method for the diagnosis of CP.
Eighty-five patients with known or suspected CP who underwent both EUS and SW-EG from October 2012 to July 2016 were included in this study. Patients were categorized into four stages using Rosemont classification and into three stages using Japan Pancreas Society clinical diagnostic criteria 2009 that was EUS-based criteria for the diagnosis of CP. SW-EG was measured five times in the pancreatic parenchyma, and the median value was defined as the pancreatic elastic modulus (PEM).
Pancreatic elastic modulus was significantly positively correlated with Rosemont classification stage (r = 0.54), Japan Pancreas Society stage (r = 0.41), and the number of EUS features (r = 0.47). Area under the receiver operating characteristic curve for the accuracy of SW-EG (consistent with CP and suggestive of CP vs normal and indeterminate for CP) was 0.77 (sensitivity 77.1%, specificity 64.9%). In a multivariate linear regression analysis including various EUS features related to PEM, hyperechoic foci with shadowing and lobularity with honeycombing were independent features related to PEM.
Chronic pancreatitis may be diagnosed noninvasively and objectively using SW-EG without performing EUS.
慢性胰腺炎（CP）有时在进展期才被诊断出来。为了对 CP 进行早期诊断，内镜超声检查（EUS）可能是一种有用的方法，但它的诊断标准是基于主观判断的。使用经腹超声的剪切波弹性成像（SW-EG）可以定量组织弹性作为绝对值，可能是诊断 CP 的一种客观、非侵入性的方法。
本研究纳入了 2012 年 10 月至 2016 年 7 月间接受 EUS 和 SW-EG 检查的 85 例已知或疑似 CP 患者。患者采用 Rosemont 分类法分为四期，采用 2009 年日本胰腺学会临床诊断标准（EUS 为 CP 诊断标准）分为三期。SW-EG 在胰腺实质中测量 5 次，取中位数作为胰腺弹性模量（PEM）。
胰腺弹性模量与 Rosemont 分类阶段呈显著正相关（r=0.54），与日本胰腺学会阶段呈显著正相关（r=0.41），与 EUS 特征数呈显著正相关（r=0.47）。SW-EG 对 CP 的准确性的受试者工作特征曲线下面积（与 CP 一致且提示 CP 与正常和不确定 CP 相比）为 0.77（敏感度 77.1%，特异度 64.9%）。在包括与 PEM 相关的各种 EUS 特征的多元线性回归分析中，伴有声影的高回声灶和蜂巢状分叶是与 PEM 相关的独立特征。
SW-EG 无需进行 EUS 检查即可对 CP 进行非侵入性和客观的诊断。
