Multiphase evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic solid lesions
Multiphase evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic solid lesions
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DOI：
10.1016/j.pan.2018.02.002
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发表时间：
2018-04-01
期刊：
影响因子：
3.6
通讯作者：
Goto, Hidemi
中科院分区：
文献类型：
--
作者：
Ishikawa, Takuya;Hirooka, Yoshiki;Goto, Hidemi
背景/目的：对比增强EUS（CE-EUS）下的时间-强度曲线（TIC）可对胰腺靶区域进行连续和定量评价。然而，TIC并不总是可用的，程序也很复杂。方法：回顾性分析210例胰腺实性病变患者的临床资料，其中胰腺导管癌142例，胰腺神经内分泌肿瘤31例，实性假乳头状肿瘤13例，肿块型胰腺炎24例。连续记录CE-EUS图像60 s，并使用20、40和60 s的每个图像进行评价。结果：在PDAC组中，大多数病灶在早期增强后注射造影剂后20 ~ 40 s表现为低回声、高回声和等回声3种类型的血管分布，且CE-EUS的多期评价结果与各疾病组的相关性较好。PDAC分型鉴别PDAC与其他病变的敏感性、特异性和准确性分别为83.1%、86.8%和84.3%。在组织病理学分析中，在组织学类型、浸润（INF）和神经浸润（NE）方面，显示PDAC模式的患者与未显示PDAC模式的患者之间存在显著差异。结论：CE-EUS的多期评价是一种方便而有用的方法，可用于胰腺实性病变的鉴别诊断，也可用于TIC。(C)2018年IAP和EPC。Elsevier B. V.出版，保留所有权利。
Background/Objectives: Time-intensity curve (TIC) under contrast-enhanced EUS (CE-EUS) allows continuous and quantitative evaluation of targeted area in the pancreas. However, TIC is not always available and the procedure is complicated. We aimed to propose a simplified method by evaluating multiple phases of CE-EUS in the diagnosis of pancreatic solid lesions.Methods: We retrospectively reviewed 210 patients with pancreatic solid lesions including 142 with pancreatic ductal cancer (PDAC), 31 with pancreatic neuroendocrine neoplasm, 13 with solid pseudo-papillary neoplasm and 24 with mass-forming pancreatitis who underwent CE-EUS and achieved final diagnoses. The CE-EUS images were continuously recorded for 60 s, and each image at 20, 40 and 60 s was used for the evaluation. The images were classified into three patterns as hypoechoic, hyperechoic and isoechoic vascular patterns compared with the surrounding pancreas, and the relevance between the multiphase evaluation of CE-EUS and each disease group was investigated.Results: In PDAC group, majority of the lesions showed hypovascular pattern at 20 or 40 s after injection of contrast medium following early enhancement. The sensitivity, specificity and accuracy of PDAC pattern in the differentiation of PDAC from other lesions was 83.1%, 86.8% and 84.3%, respectively. On histopathological analysis, significant differences were seen in histologic types, infiltration (INF), and neural invasion (ne) between those who showed PDAC pattern and those who didn't.Conclusions: Multiphase evaluation of CE-EUS is convenient and useful method for the differentiation of pancreatic solid lesions which can be alternatively used for TIC. (C) 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.