Lu Xiu-Yun, Cao Jia-Ying, Chen Sheng, Wang Ying, Wei Li, Gong Wei, Lou Wen-Hui, Dong Yi
Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Ultrasound Med Biol. 2025 Mar;51(3):535-542. doi: 10.1016/j.ultrasmedbio.2024.11.015. Epub 2025 Jan 2.
To evaluate the added value of dynamic contrast-enhanced ultrasound (DCE-US) analysis in pre-operative differential diagnosis of small (≤20 mm) solid pancreatic lesions (SPLs).
In this retrospective study, patients with biopsy or surgerical resection and histopathologically confirmed small (≤20 mm) SPLs were included. One wk before biopsy/surgery, pre-operative B-mode ultrasound and contrast-enhanced ultrasound were performed. An ultrasonic system (ACUSON Sequoia, Siemens Medical Solutions, PA, USA) equipped with a 5C1 MHz convex array transducer was utilized. A dose of 1.5 ml SonoVue (Bracco, Italy) was injected as the contrast agent. Time-intensity curves were generated using VueBox software (Bracco) and various DCE-US quantitative parameters were subsequently calculated after curve fitting. Univariate and multivariate logistic regression analysis were utilized.
From August 2020 to November 2023, a total of 76 patients (31 males and 45 females; mean age: 61.9 ± 10.5 y) with 76 small (≤20 mm) SPLs were included. Mean size of the lesions was 16.4 ± 0.4 mm (range: 7-20 mm). Final diagnosis included 37 benign and 39 malignant small SPLs. On B-mode ultrasound, the majority of malignant (37/39, 94.9%) and benign SPLs (30/37, 81.1%) were hypo-echoic lesions with ill-defined borders and irregular shapes (p > 0.05). During the arterial phase of contrast-enhanced ultrasound, most SPLs (59/76, 77.6%) exhibited iso-enhancement when compared with surrounding pancreatic parenchyma. Subsequently, 82.1% (32/39) of malignant SPLs and 35.1% (13/37) of benign SPLs demonstrated wash-out in the venous phase and showed hypo-enhancement in venous and late phases (p > 0.05). Compared with benign SPLs, the time-intensity curves of small malignant SPLs revealed earlier and lower enhancement in the arterial phase, and a faster decline during the venous phase with a decreased area under the curve. Among the quantitative parameters, a lower peak enhancement ratio and higher fall time ratio were more common in small malignant SPLs (p < 0.05). For DCE-US analysis, the combined areas under the curve of significant quantitative parameters was 0.919, with 87.2% sensitivity and 86.5% specificity when differentiating between small malignant and benign SPLs. This result was better than contrast-enhanced computed tomography, which has a sensitivity of 74.4% and a specificity of 75.7%.
DCE-US analysis provides added value for the pre-operative differential diagnosis of small malignant SPLs.
评估动态对比增强超声（DCE-US）分析在术前鉴别诊断小（≤20 mm）实性胰腺病变（SPL）中的附加价值。
本回顾性研究纳入了经活检或手术切除且组织病理学确诊为小（≤20 mm）SPL的患者。在活检/手术前1周，进行术前B超和对比增强超声检查。使用配备5C1 MHz凸阵探头的超声系统（美国宾夕法尼亚州西门子医疗解决方案公司的ACUSON Sequoia）。注入1.5 ml声诺维（意大利博莱科公司）作为造影剂。使用VueBox软件（博莱科公司）生成时间-强度曲线，并在曲线拟合后计算各种DCE-US定量参数。采用单因素和多因素逻辑回归分析。
2020年8月至2023年11月，共纳入76例患者（男性31例，女性45例；平均年龄：61.9±10.5岁），伴有76个小（≤20 mm）SPL。病变平均大小为16.4±0.4 mm（范围：7 - 20 mm）。最终诊断包括37个良性和39个恶性小SPL。在B超检查中，大多数恶性（37/39，94.9%）和良性SPL（30/37，81.1%）为低回声病变，边界不清，形态不规则（p>0.05）。在对比增强超声的动脉期，与周围胰腺实质相比，大多数SPL（59/76，77.6%）表现为等增强。随后，82.1%（32/39）的恶性SPL和35.1%（13/37）的良性SPL在静脉期表现为廓清，在静脉期和延迟期表现为低增强（p>0.05）。与良性SPL相比，小恶性SPL的时间-强度曲线在动脉期显示增强更早、更低，在静脉期下降更快，曲线下面积减小。在定量参数中，小恶性SPL中较低的峰值增强率和较高的下降时间率更为常见（p<0.05）。对于DCE-US分析，显著定量参数的联合曲线下面积为0.919，在鉴别小恶性和良性SPL时，敏感性为87.2%，特异性为86.5%。这一结果优于对比增强计算机断层扫描，其敏感性为74.4%，特异性为75.7%。
DCE-US分析为术前鉴别诊断小恶性SPL提供了附加价值。
