对比增强谐波内镜超声结合定性和定量分析对胰腺实性肿瘤的疗效：一项前瞻性初步研究
Efficacy of Contrast-Enhanced Harmonic Endoscopic Ultrasound for Pancreatic Solid Tumors with a Combination of Qualitative and Quantitative Analyses: A Prospective Pilot Study.
作者信息
Iwasa Yuhei, Iwashita Takuji, Ichikawa Hironao, Mita Naoki, Uemura Shinya, Yoshida Kensaku, Iwata Keisuke, Mukai Tsuyoshi, Yasuda Ichiro, Shimizu Masahito
机构信息
First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
出版信息
Dig Dis Sci. 2022 Mar;67(3):1054-1064. doi: 10.1007/s10620-021-06931-5. Epub 2021 Mar 17.
INTRODUCTION
Image evaluation of contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and additional time-intensity curve (TIC) analysis enable qualitative and quantitative analyses of pancreatic tumor based on real-time perfusion imaging.
AIMS
To evaluate the efficacy of CEH-EUS with a combination of qualitative and quantitative analyses of pancreatic solid tumors.
METHODS
Patients were scheduled to undergo EUS-guided fine needle aspiration (FNA) for pancreatic solid tumors were prospectively enrolled between 11/2016 and 12/2018 and underwent CEH-EUS. The vascular and enhancement patterns were qualitatively evaluated and heterogeneous enhancement was defined to be indicative of malignancy. The echo intensity change during 60 s in the tumor was quantitatively evaluated by time intensity curve analysis.
RESULTS
In total, 100 patients were enrolled in this study. The final diagnoses were malignant lesions in 87 patients and benign legions in 13 patients. There were four categories of enhancement and patterns: hypovascular with heterogeneous, hypovascular with homogeneous, hypervascular heterogeneous, and hypervascular homogeneous enhancement. The diagnostic capability of qualitative analysis was the sensitivity, specificity, and accuracy of 89%, 62%, and 85%, respectively. With respect to time intensity curve analysis, the time to peak of malignant lesions was significantly shorter than those of benign lesions (P = 0.0009) with an optimal cutoff value of 12.81 s on the receiver operating characteristic curve analysis. With the combination of qualitative and quantitative analyses, the sensitivity, specificity, and accuracy were improved to 100%, 54%, and 94%, respectively.
CONCLUSIONS
CEH-EUS with combined qualitative and quantitative analyses for pancreatic tumors might be useful as a complement for EUS-FNA. The UMIN Clinical Trials Registry (UMIN000025192).
引言
对比增强谐波内镜超声（CEH-EUS）的图像评估及额外的时间-强度曲线（TIC）分析能够基于实时灌注成像对胰腺肿瘤进行定性和定量分析。
目的
评估CEH-EUS联合胰腺实性肿瘤定性和定量分析的有效性。
方法
2016年11月至2018年12月期间，前瞻性纳入计划接受胰腺实性肿瘤EUS引导下细针穿刺抽吸（FNA）的患者，并对其进行CEH-EUS检查。对血管和增强模式进行定性评估，不均匀增强被定义为恶性的指征。通过时间-强度曲线分析对肿瘤60秒内的回声强度变化进行定量评估。
结果
本研究共纳入100例患者。最终诊断为恶性病变87例，良性病变13例。有四类增强和模式：低血供不均匀、低血供均匀、高血供不均匀和高血供均匀增强。定性分析的诊断能力为敏感性、特异性和准确性分别为89%、62%和85%。关于时间-强度曲线分析，恶性病变的达峰时间显著短于良性病变（P = 0.0009），在受试者工作特征曲线分析中最佳截断值为12.81秒。定性和定量分析相结合，敏感性、特异性和准确性分别提高到100%、54%和94%。
结论
CEH-EUS联合胰腺肿瘤定性和定量分析可能作为EUS-FNA的一种补充手段。UMIN临床试验注册库（UMIN000025192）。
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