Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
Pancreatology. 2018 Apr;18(3):291-297. doi: 10.1016/j.pan.2018.02.002. Epub 2018 Feb 9.
BACKGROUND/OBJECTIVES: Time-intensity curve (TIC) under contrast-enhanced EUS (CE-EUS) allows continuous and quantitative evaluation of targeted area in the pancreas. However, TIC is not always available and the procedure is complicated. We aimed to propose a simplified method by evaluating multiple phases of CE-EUS in the diagnosis of pancreatic solid lesions.
We retrospectively reviewed 210 patients with pancreatic solid lesions including 142 with pancreatic ductal cancer (PDAC), 31 with pancreatic neuroendocrine neoplasm, 13 with solid pseudopapillary neoplasm and 24 with mass-forming pancreatitis who underwent CE-EUS and achieved final diagnoses. The CE-EUS images were continuously recorded for 60 s, and each image at 20, 40 and 60 s was used for the evaluation. The images were classified into three patterns as hypoechoic, hyperechoic and isoechoic vascular patterns compared with the surrounding pancreas, and the relevance between the multiphase evaluation of CE-EUS and each disease group was investigated.
In PDAC group, majority of the lesions showed hypovascular pattern at 20 or 40 s after injection of contrast medium following early enhancement. The sensitivity, specificity and accuracy of PDAC pattern in the differentiation of PDAC from other lesions was 83.1%, 86.8% and 84.3%, respectively. On histopathological analysis, significant differences were seen in histologic types, infiltration (INF), and neural invasion (ne) between those who showed PDAC pattern and those who didn't.
Multiphase evaluation of CE-EUS is convenient and useful method for the differentiation of pancreatic solid lesions which can be alternatively used for TIC.
背景/目的：超声造影（CE-EUS）下的时间-强度曲线（TIC）允许对胰腺的目标区域进行连续和定量评估。然而，TIC 并不总是可用，且操作复杂。我们旨在提出一种通过评估 CE-EUS 的多个相来诊断胰腺实性病变的简化方法。
我们回顾性分析了 210 例胰腺实性病变患者的资料，包括 142 例胰腺导管腺癌（PDAC）、31 例胰腺神经内分泌肿瘤、13 例实性假乳头状瘤和 24 例肿块型胰腺炎，这些患者均接受了 CE-EUS 检查并获得了最终诊断。CE-EUS 图像连续记录 60 秒，分别在 20、40 和 60 秒评估图像。将图像与周围胰腺相比分为低回声、高回声和等回声血管模式，并研究 CE-EUS 多相评估与各疾病组之间的相关性。
在 PDAC 组中，大多数病变在注射造影剂后 20 或 40 秒时表现为低灌注模式，随后出现早期增强。PDAC 模式在 PDAC 与其他病变的鉴别诊断中的敏感性、特异性和准确性分别为 83.1%、86.8%和 84.3%。组织病理学分析显示，表现为 PDAC 模式与未表现为 PDAC 模式的患者之间在组织学类型、浸润（INF）和神经侵犯（ne）方面存在显著差异。
CE-EUS 的多相评估是一种方便且有用的胰腺实性病变鉴别方法，可替代 TIC 使用。
