Improved differentiation of pancreatic tumors using contrast-enhanced endoscopic ultrasound
Improved differentiation of pancreatic tumors using contrast-enhanced endoscopic ultrasound
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DOI：
10.1016/j.cgh.2008.02.030
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发表时间：
2008-05-01
影响因子：
12.6
通讯作者：
Hocke, Michael
中科院分区：
文献类型：
--
作者：
Dietrich, Christoph F.;Ignee, Andre;Hocke, Michael
背景和目标：超声内镜是胰腺导管腺癌分期和神经内分泌肿瘤定位的一种广泛接受的成像方法。我们前瞻性评价了传统彩色多普勒成像和对比增强内镜多普勒超声（CE-EDUS）作为一种新的成像技术，用于进一步表征和鉴别胰腺实体瘤。研究方法：从300例胰腺病变患者使用对比增强内镜超声研究，我们最终可以包括93例未确定的，孤立的，主要是固体，病变40毫米或更小，并明确的组织学证实的诊断。团注造影剂SHU 508 A 4 g（400 mg/dL）后，将动脉期病变的血管模式与残留胰腺实质的血管分布进行比较。结果如下：彩色多普勒成像未显示任何患者胰腺实质的血管分布，因此与所有CE-EDUS检查的患者显示至少一定程度的实质血管分布相比，无法确定肿瘤血管分布不足。62例胰腺导管腺癌患者中有57例使用CE-EDUS显示肿瘤血管减少。所有其他胰腺病变显示了等血管或多血管模式，使用对比增强内镜超声（20神经内分泌肿瘤，10浆液性微囊性腺瘤，和1畸胎瘤）。超声造影诊断恶性肿瘤的敏感性为92%（82%-97%），特异性为100%（89%-100%）。结论：超声造影内镜对胰腺小实性肿瘤的鉴别诊断具有重要价值。血供减少提示胰腺肿瘤恶性。
Background & Aims: Endoscopic ultrasound is a widely accepted imaging method for staging of ductal adenocarcinoma and the localization of neuroendocrine tumors of the pancreas. We prospectively evaluated conventional color Doppler imaging and contrast-enhanced endoscopic Doppler ultrasound (CE-EDUS) as a new imaging technique for further characterization and differentiation of solid pancreatic tumors. Methods: From 300 patients with pancreatic lesions investigated using contrast-enhanced endoscopic ultrasound we could finally include 93 patients with an undetermined, solitary, predominantly solid, lesion 40 mm or less, and a definite histologically proven diagnosis. After bolus injection of the contrast agent SHU 508A 4 g (400 mg/dL) the vascular pattern of the lesion during the arterial phase was compared with the vascularity of the residual pancreatic parenchyma. Results: Color Doppler imaging did not reveal vascularity of the pancreatic parenchyma in any of the patients, and therefore tumor hypovascularity could not be determined in contrast to all CE-EDUS-examined patients revealing at least some degree of parenchymal vascularity. Fifty-seven of 62 patients with ductal adenocarcinoma of the pancreas showed a hypovascularity of the tumor using CE-EDUS. All other pancreatic lesions revealed an isovascular or hypervascular pattern using contrast-enhanced endoscopic ultrasound (20 neuroendocrine tumors, 10 serous microcystic adenomas, and 1 teratoma). Hypovascularity as a sign of malignancy in contrast-enhanced endoscopic ultrasound obtained 92% (82%-97%) sensitivity and 100% specificity (89%-100%). Conclusions: Contrast-enhanced endoscopic ultrasound is effective in differentiating small solid pancreatic tumors of different origin in most cases. Hypovascularity indicates malignancy of pancreatic tumors.