Differential diagnosis of pancreatic tumors using ultrasound contrast imaging
Differential diagnosis of pancreatic tumors using ultrasound contrast imaging
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DOI：
10.1007/s00535-005-1578-z
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发表时间：
2005-05-01
影响因子：
6.3
通讯作者：
Itoi, T
中科院分区：
文献类型：
--
作者：
Sofuni, A;Iijima, H;Itoi, T
背景资料。超声成像设备和造影剂的发展促进了胰腺肿瘤诊断的重大突破。我们的目的是利用代理检测成像(ADI)技术，确定Levovist声学造影剂对50例胰腺肿瘤的诊断效果。方法：研究方法。我们研究了50例经组织学证实的胰腺疾病，39例胰腺癌，2例内分泌肿瘤，4例导管内乳头状黏液性癌(IPMC)和5例肿瘤性胰腺炎(TFP)。超声造影(CE-US)血管成像和灌注成像分别用于评价肿瘤的血管和实质血流灌注情况。比较CE-US对肿瘤的血流动力学和诊断能力，并与CT进行比较。所有病例的组织学诊断均来自活检或手术标本。结果。胰腺癌34例(87%)表现为低血管、低灌注型。内分泌肿瘤表现为不均匀的高血管、高灌注型。所有IPMC病例均显示肿瘤内结节血运丰富。TFP呈等血管均匀等灌注型。当在CE-US上表现为低血管或低血流模式的肿瘤被诊断为癌时，39例癌中34例(87%)符合这一标准，其95%可信区间(CI)为73%-96%，而在CT上，39例中31例被诊断为癌(敏感性为79%)。CT的敏感性和准确性均低于CE-US。CE-US所见与组织学诊断的对照结果如下。1例乳头状腺癌表现为多血管、高灌注型，32例中、高分化腺癌表现为低血管、低灌注型，2例硬化型表现为低血管、低灌注型，4例髓质型表现为等血管、等灌注型。结论。CE-US所显示的胰腺癌血管的差异与组织学上的差异有很好的相关性。应用ADI技术的CE-US对胰腺肿瘤的诊断有重要价值。
Background. The development of equipment and contrast agents for ultrasound imaging has contributed to major breakthroughs in the diagnosis of pancreatic tumors. We aimed to determine the diagnostic effectiveness of contrast ultrasound with Levovist, using the Agent Detection Imaging (ADI) technique, in 50 patients with pancreatic tumors. Methods. We studied 50 cases of histologically proven pancreatic disease; 39 carcinomas, 2 endocrine tumors, 4 intraductal papillary mucinous carcinomas (IPMCs), and 5 cases of tumor-forming pancreatitis (TFP). Vascular and perfusion images of contrast-enhanced ultrasound (CE-US) were used for the evaluation of tumor vascularity and parenchymal perfusion of the tumor, respectively. The hemodynamics of the tumor, and the diagnostic capacity of CE-US were compared with those shown by computed tomography (CT). The histological diagnosis in all cases was made from either biopsy or surgical specimens. Results. Thirty-four cases of pancreatic carcinoma (87%) showed a hypovascular and hypoperfusion pattern. The endocrine tumors showed a heterogeneous hypervascular and hyperperfusion pattern. All IPMC cases showed hypervascularity of the nodules inside the tumors. TFP showed an isovascular and homogeneous isoperfusion pattern. When tumors showing a hypovascular or hypoperfusion pattern on CE-US were diagnosed as carcinomas, 34 of the 39 carcinomas (87%) fit this criterion, with a 95% confidence interval (CI) of 73%- 96%, whereas, on CT, 31 of the 39 were diagnosed as carcinoma; (sensitivity, 79%). The sensitivity and accuracy of CT were inferior to those of CE-US. Results of comparison between the CE-US findings and the histological diagnosis were as follows. The one papillary adenocarcinoma showed a hypervascular and hyperperfusion pattern; the 32 well or moderately differentiated adenocarcinomas showed a hypovascular and hypoperfusion pattern; and in the poorly differentiated adenocarcinomas, 2 cases of scirrhous type showed a hypovascular and hypoperfusion pattern, and the 4 cases of medullary type showed an isovascular and isoperfusion pattern. Conclusions. The differences in vascularity of pancreatic carcinomas depicted by CE-US were associated well with differences in histology. CE-US, by the ADI technique, is useful for the diagnosis of pancreatic tumors.