Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions
Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions
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DOI：
10.1055/s-2008-1077726
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发表时间：
2008-11-01
期刊：
影响因子：
9.3
通讯作者：
Dietrich, C. F.
中科院分区：
文献类型：
--
作者：
Hirche, T. O.;Ignee, A.;Dietrich, C. F.
背景和研究目的：内窥镜超声引导弹性成像（EUS-弹性成像）是最近引入的成像程序，其基于组织的特定一致性来区分组织。这项前瞻性研究的目的是探讨这种新技术的特点和分化局灶性胰腺insulines.Patients和方法的作用：这项前瞻性研究招募了70例胰腺未分类的实体病变和10个健康胰腺对照。在所有患者的弹性成像记录进行了比较，细胞学/组织学的结果作为金standard.Results：充分EUS弹性成像的胰腺进行了所有健康对照，但只有56%的患者与固体胰腺病变。弹性成像图像采集的主要局限性是直径大于35 mm的病变（39%）或距离换能器一定距离的病变（10%）的边界描绘不完整。弹性成像记录也受到以下事实的阻碍：在较大病变的情况下，作为应变计算内部参考标准的周围组织显示不充分。目标与周围组织的比率降低导致形成颜色伪影和再现性受损。相比之下，大多数直径小于35 mm的病变通过EUS弹性成像进行了充分和可重复的评价（91%）。然而，用于鉴别诊断的临床用途似乎是有限的，因为发现来自所有类型的胰腺肿块的应变图像比周围组织更硬，而不管病变的潜在性质（即，恶性对良性）。超声内镜弹性成像预测胰腺病变的性质，诊断敏感性（41%），特异性（53%）和准确性（45%）。结论：超声内镜弹性成像的胰腺有可能获得一些补充信息，将改善组织定征。然而，它的临床效用仍然值得怀疑，并且似乎不太可能提供的信息将证明获得组织样本以确认最终病理诊断的必要性。
Background and study aim: Endoscopic-ultrasound-guided elastography (EUS-elastography) is a recently introduced imaging procedure that distinguishes tissues on the basis of their specific consistency. The aim of this prospective study was to investigate the role of this new technique in the characterization and differentiation of focal pancreatic lesions.Patients and methods: This prospective study enrolled 70 patients with unclassified solid lesions of the pancreas and 10 controls with a healthy pancreas. In all patients elastography recordings were compared with cytology/histology findings as the gold standard.Results: Adequate EUS-elastography of the pancreas was performed in all healthy controls but in only 56% of patients with solid pancreatic lesions. The main limitation of elastographic image acquisition was incomplete delineation of the border of lesions greater than 35 mm in diameter (39%) or of lesions at some distance from the transducer (10%). Elastographic recordings were also hampered by the fact that the surrounding tissue, which is used as an internal reference standard for strain calculation, was insufficiently displayed in the case of larger lesions. The reduced ratio of target to surrounding tissue resulted in the formation of color artifacts and in impaired reproducibility. In contrast, the majority of lesions smaller than 35 mm in diameter were adequately and reproducibly evaluated by EUS-elastography (91%). The clinical use for differential diagnosis, however, seems limited, since strain images from all kinds of pancreatic masses were found to be harder than the surrounding tissues, irrespective of the underlying nature of the lesion (i.e., malignant vs. benign). EUS-elastography predicted the nature of pancreatic lesions with poor diagnostic sensitivity (41%), specificity (53%), and accuracy (45%).Conclusion: EUS-elastography of the pancreas has the potential to obtain some complementary information that would improve tissue characterization. Its clinical utility, however, remains questionable, and it seems unlikely that the information provided will obviate the necessity of obtaining tissue samples for confirmation of a final pathologic diagnosis.