Yamashita Yasunobu, Yamazaki Hirofumi, Shimokawa Toshio, Kawaji Yuki, Tamumra Takashi, Hatamaru Keiichi, Itonaga Masahiro, Ashida Reiko, Kitano Masayuki
Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan.
Pancreatology. 2023 Jan;23(1):35-41. doi: 10.1016/j.pan.2022.11.009. Epub 2022 Nov 24.
/Objectives: Endoscopic ultrasound (EUS) elastography is a non-invasive diagnostic method for evaluating tissue elasticity. The aims of this study were to compare shear-wave elastography (SWE) and conventional strain elastography (SE) in determination of the diagnosis and degree of chronic pancreatitis (CP).
Forty-nine patients who underwent computed tomography (CT), EUS-SWE, EUS-SE, and pancreatic exocrine function testing between January 2019 and January 2022 were prospectively evaluated. CP was diagnosed according to Japan Pancreatic Society criteria (JPSC) 2019, Rosemont criteria (RC), CT findings, and pancreatic exocrine dysfunction. The cut-off values, sensitivity, and specificity for CP diagnosed according to the four criteria were calculated for EUS-SWE and EUS-SE. Relationships between values measured by either of the EUS elastography methods and the number of EUS features were also assessed.
EUS-SWE values were positively correlated with the severity grades of RC and JPSC, but EUS-SE values were not. EUS-SWE was significantly better than EUS-SE for diagnosing CP defined according to CT findings (area under the receiver operating characteristics curve [AUROC]: 0.77 vs. 0.61, P < 0.001), RC (AUROC: 0.85 vs. 0.56, P < 0.001), JPSC 2019 (AUROC: 0.83 vs. 0.53, P < 0.001), and exocrine dysfunction (AUROC: 0.78 vs. 0.61, P < 0.001). EUS-SWE values were positively correlated with the number of EUS features, but EUS-SE values were not.
EUS-SWE provides objective assessment for diagnosing and assessing the degree of CP defined according to the criteria of CT findings, RC, JPSC, or exocrine dysfunction, and it can be considered a non-invasive diagnostic tool for CP and exocrine dysfunction.
/目的：内镜超声弹性成像（EUS）是一种评估组织弹性的非侵入性诊断方法。本研究旨在比较剪切波弹性成像（SWE）和传统应变弹性成像（SE）在慢性胰腺炎（CP）诊断及病情程度判断中的应用。
对2019年1月至2022年1月期间接受计算机断层扫描（CT）、EUS-SWE、EUS-SE及胰腺外分泌功能检测的49例患者进行前瞻性评估。根据日本胰腺学会标准（JPSC）2019版、罗斯蒙特标准（RC）、CT检查结果及胰腺外分泌功能障碍诊断CP。计算EUS-SWE和EUS-SE诊断CP时依据上述四项标准的临界值、敏感性及特异性。同时评估两种EUS弹性成像方法所测值与EUS特征数量之间的关系。
EUS-SWE值与RC及JPSC的严重程度分级呈正相关，而EUS-SE值则无此相关性。对于依据CT检查结果定义的CP，EUS-SWE在诊断方面显著优于EUS-SE（受试者操作特征曲线下面积[AUROC]：0.77对0.61，P<0.001）；对于依据RC定义的CP（AUROC：0.85对0.56，P<0.001）；对于依据JPSC 2019定义的CP（AUROC：0.83对0.53，P<0.001）；对于依据外分泌功能障碍定义的CP（AUROC：0.78对0.61，P<0.001）。EUS-SWE值与EUS特征数量呈正相关，而EUS-SE值则无此相关性。
EUS-SWE可为依据CT检查结果、RC、JPSC或外分泌功能障碍标准诊断及评估CP病情程度提供客观评估，可被视为CP及外分泌功能障碍的非侵入性诊断工具。
