经对比增强超声预测的伴有同步和异时性肝转移的胰腺导管腺癌

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound.

作者信息

Jia Wan-Ying, Gui Yang, Chen Xue-Qi, Tan Li, Zhang Jing, Xiao Meng-Su, Chang Xiao-Yan, Sang Xin-Ting, Dai Meng-Hua, Guo Jun-Chao, Bai Chun-Mei, Cheng Yue-Juan, Li Jing-Lin, Yang Xin, Li Jian-Chu, Jiang Yu-Xin, Lv Ke

机构信息

Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Quant Imaging Med Surg. 2023 Jun 1;13(6):3902-3914. doi: 10.21037/qims-22-1132. Epub 2023 Apr 24.

DOI:10.21037/qims-22-1132

PMID:37284072

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10240015/

Abstract

BACKGROUND

Contrast-enhanced ultrasound (CEUS) has proven valuable in diagnosing benign and malignant pancreatic diseases, but its value in evaluating hepatic metastasis remains to be further explored. This study investigated the relationship between CEUS features of pancreatic ductal adenocarcinoma (PDAC) and concomitant or recurrent liver metastases after treatment.

METHODS

This retrospective study included 133 participants with PDAC who were diagnosed with pancreatic lesions with CEUS at Peking Union Medical College Hospital from January 2017 to November 2020. According to the CEUS classification methods in our center, all the pancreatic lesions were classified as either with rich or poor blood supply. Additionally, quantitative ultrasonographic parameters were measured in the center and periphery of all pancreatic lesions. CEUS modes and parameters of the different hepatic metastasis groups were compared. The diagnostic performance of CEUS was calculated for diagnosing synchronous and metachronous hepatic metastasis.

RESULTS

The proportions of rich blood supply and poor blood supply were 46% (32/69) and 54% (37/69), respectively, in the no hepatic metastasis group; 42% (14/33) and 58% (19/33), respectively, in the metachronous hepatic metastasis (MHM) group; and 19% (6/31) and 81% (25/31), respectively, in the synchronous hepatic metastasis (SHM) group. The wash-in slope ratio (WIS ratio) between the center of the lesion and around the lesion and peak intensity ratio (PI ratio) between the center of the lesion and around the lesion had higher values in the negative hepatic metastasis group (P<0.05). In predicting synchronous and metachronous hepatic metastasis, the WIS ratio had the best diagnostic performance. The sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) were 81.8%, 95.7%, 91.2%, 90.0%, and 91.7%, respectively, for MHM; and 87.1%, 95.7%, 93.0%, 90.0%, and 94.3%, respectively, for SHM.

CONCLUSIONS

CEUS would be helpful in image surveillance for synchronous or metachronous hepatic metastasis of PDAC.

摘要

背景

超声造影（CEUS）在诊断胰腺良恶性疾病方面已被证明具有重要价值，但其在评估肝转移方面的价值仍有待进一步探索。本研究探讨了胰腺导管腺癌（PDAC）的CEUS特征与治疗后伴发或复发性肝转移之间的关系。

方法

本回顾性研究纳入了2017年1月至2020年11月在北京协和医院经CEUS诊断为胰腺病变的133例PDAC患者。根据本中心的CEUS分类方法，所有胰腺病变被分为血供丰富或血供贫乏。此外，在所有胰腺病变的中心和周边测量定量超声参数。比较不同肝转移组的CEUS模式和参数。计算CEUS诊断同时性和异时性肝转移的诊断性能。

结果

无肝转移组血供丰富和血供贫乏的比例分别为46%（32/69）和54%（37/69）；异时性肝转移（MHM）组分别为42%（14/33）和58%（19/33）；同时性肝转移（SHM）组分别为19%（6/31）和81%（25/31）。病变中心与病变周围的流入斜率比（WIS比）以及病变中心与病变周围的峰值强度比（PI比）在肝转移阴性组中较高（P<0.05）。在预测同时性和异时性肝转移方面，WIS比具有最佳的诊断性能。对于MHM，敏感性（SEN）、特异性（SPE）、准确性（ACC）、阳性预测值（PPV）和阴性预测值（NPV）分别为81.8%、95.7%、91.2%、90.0%和91.7%；对于SHM，分别为87.1%、95.7%、93.0%、90.0%和94.3%。