Department of Gastroenterology, Military Institute of Medicine, Poland.
Institute of Physiology, Medical University of Graz, Graz, Austria.
PLoS One. 2019 Apr 29;14(4):e0215944. doi: 10.1371/journal.pone.0215944. eCollection 2019.
Differentiation between pancreatic malignant and inflammatory tumors presents an important diagnostic problem. The ability to recognize pancreatic malignant tumors using Doppler evaluation of tissue perfusion has been recently demonstrated. The aim of the study was to assess the diagnostic value of Dynamic Tissue Perfusion Measurement (DTPM) in the differentiation between malignant and inflammatory pancreatic tumors. The study included 60 patients (35M, 25F, age 60.9 ± 2.3 years) with a malignant (Group 1, n = 30) or inflammatory (Group 2, n = 30) pancreatic tumor undergoing endoscopic ultrasound with the evaluation of tissue perfusion by Color Doppler and a simultaneous biopsy of lesions for cytological evaluation. In 20 patients the diagnosis was verified in the postoperative histopathological examination. Flow velocity (FV) and percentiles of the distribution of perfusion intensity (PR) evaluated by DTPM were analyzed with regard to receiver-operator-characteristics. FV as well as PR were significantly higher in Group 2 compared to Group 1. A threshold of 2.0 cm/sec for FV identified patients with malignancies with a sensitivity of 83% and specificity of 86%. In multivariable regression analysis, the best PR parameter for differentiating between malignant and inflammatory tumors was 97.5% percentile, whose value of 0.922 allowed for the recognition of pancreatic malignant tumors with a sensitivity of 62% and specificity of 83% (p < 0.001). In conclusion, Color Doppler ultrasound tissue perfusion parameters are a sensitive and specific tool in the differentiation between malignant and inflammatory pancreatic tumors.
胰腺良恶性肿瘤的鉴别诊断是一个重要的问题。最近已经证明，使用多普勒评估组织灌注来识别胰腺恶性肿瘤的能力。本研究的目的是评估动态组织灌注测量（DTPM）在鉴别胰腺良恶性肿瘤中的诊断价值。本研究纳入了 60 名患者（35 名男性，25 名女性，年龄 60.9 ± 2.3 岁），这些患者患有胰腺恶性肿瘤（第 1 组，n = 30）或胰腺炎症性肿瘤（第 2 组，n = 30），这些患者均接受了内镜超声检查，同时通过彩色多普勒评估组织灌注，并对病变进行细胞学评估。在 20 例患者中，通过术后组织病理学检查证实了诊断。通过 DTPM 评估的流速（FV）和灌注强度分布的百分位数（PR）进行了分析，同时还进行了接受者操作特征（ROC）分析。FV 和 PR 在第 2 组明显高于第 1 组。FV 的阈值为 2.0 cm/sec 时，可以识别出恶性肿瘤患者，其敏感性为 83%，特异性为 86%。在多变量回归分析中，区分良恶性肿瘤的最佳 PR 参数是 97.5%分位数，其值为 0.922，可识别胰腺恶性肿瘤，敏感性为 62%，特异性为 83%（p < 0.001）。总之，彩色多普勒超声组织灌注参数是鉴别胰腺良恶性肿瘤的一种敏感且特异的工具。
