Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: results of a pilot study
Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: results of a pilot study
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DOI：
10.1055/s-0030-1255537
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发表时间：
2010-07-01
期刊：
影响因子：
9.3
通讯作者：
Ponchon, T.
中科院分区：
文献类型：
--
作者：
Napoleon, B.;Alvarez-Sanchez, M. V.;Ponchon, T.
背景和研究目的：目前的影像学技术对胰腺癌与其他胰腺肿块的鉴别仍具有挑战性。这项前瞻性研究的目的是评估一个新的程序的准确性，成像胰腺的微循环模式，通过对比增强谐波内镜超声（CEH-EUS）与一个新的奥林巴斯原型回声endoscope.Patients和方法：35例胰腺实质性病变的患者进行了前瞻性登记。所有患者均行常规B模式和能量多普勒超声内镜检查。静脉推注2.4 ml第二代超声造影剂（SonoVue）后，使用新型Olympus原型回声内窥镜（xGF-UCT 180）进行CEH-EUS。微血管模式进行了比较，根据手术或超声内镜引导下细针穿刺活检（EUS-FNA）或随访至少12个月的标本的病理检查的最终诊断为：腺癌18例，神经内分泌肿瘤9例，慢性胰腺炎7例，间质瘤1例。能量多普勒未能显示微循环，而谐波成像显示在所有情况下。在CEH-EUS上呈低信号的18个病灶中，16个为腺癌。诊断胰腺癌的敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）和低信号准确性分别为89%、88%、88%、89%和88.5%，而EUS-FNA的相应值分别为72%、100%、77%、100%和86%。五个腺癌的假阴性结果在EUS-FNA，四个有一个低信号的回声在CEH-EUS.Conclusions：CEH-EUS与新的奥林巴斯原型设备成功地可视化胰腺实体病变的微血管模式，并可能是有用的区分腺癌从其他胰腺肿块。
Background and study aims: Distinguishing pancreatic adenocarcinoma from other pancreatic masses remains challenging with current imaging techniques. This prospective study aimed to evaluate the accuracy of a new procedure, imaging the microcirculation pattern of the pancreas by contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) with a new Olympus prototype echo endoscope.Patients and methods: 35 patients presenting with solid pancreatic lesions were prospectively enrolled. All patients had conventional B mode and power Doppler EUS. After an intravenous bolus injection of 2.4 ml of a second-generation ultrasound contrast agent (SonoVue) CEH-EUS was then performed with a new Olympus prototype echo endoscope (xGF-UCT 180). The microvascular pattern was compared with the final diagnosis based on the pathological examination of specimens from surgery or EUS-guided fine-needle aspiration (EUS-FNA) or on follow-up for at least 12 months.Results: The final diagnoses were: 18 adenocarcinomas, 9 neuroendocrine tumors, 7 chronic pancreatitis, and 1 stromal tumor. Power Doppler failed to display microcirculation, whereas harmonic imaging demonstrated it in all cases. Out of 18 lesions with a hypointense signal on CEH-EUS, 16 were adenocarcinomas. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of hypointensity for diagnosing pancreatic adenocarcinoma were 89%, 88%, 88%, 89%, and 88.5%, compared with corresponding values of 72%, 100%, 77%, 100%, and 86% for EUS-FNA. Of five adenocarcinomas with false-negative results at EUS-FNA, four had a hypointense echo signal at CEH-EUS.Conclusions: CEH-EUS with the new Olympus prototype device successfully visualizes the microvascular pattern in pancreatic solid lesions, and may be useful for distinguishing adenocarcinomas from other pancreatic masses.