CAJ | 학술논문

目的通过定量分析造影剂增强后EUS影像的不同特征,为胰腺病变的影像鉴别诊断提供客观依据.方法对32例临床或其他影像检查疑有或确诊胰腺良、恶性占位病变、慢性胰腺炎的患者以及19例因其他上消化道原因行EUS检查的胰腺正常患者为检查对象,观察造影增强EUS检查时感兴趣区域的血流灌注增强特征,同时使用造影分析软件进行定量分析.以EUS引导下细针穿刺细胞学和(或)组织病理学结果、手术病理结果为最终诊断.结果造影增强EUS后定量分析显示,19例正常胰腺的峰值强度(PI)值为0.648±0.174,通过比较,发现其与胰腺癌和胰腺囊性病灶的PI值之间的差异具统计学意义,且通过ROC曲线得出正常胰腺与胰腺癌之间PI值的最佳诊断临界值为0.505,诊断敏感度、特异度分别为100.0%、84.2%.6例慢性胰腺炎PI值较大,为0.772±0.106.在胰腺占位性病灶中,胰腺癌与胰腺囊性病灶及胰腺内分泌肿瘤之间PI值的差异亦具统计学意义,且通过ROC曲线得出胰腺癌与胰腺囊性病灶之间PI值的最佳诊断临界值为0.195,诊断敏感度、特异度分别为85.7%、87.5%.14例胰腺癌的PI值为0.321±0.119,4例胰腺内分泌肿瘤的PI值为0.763±0.115.通过病灶内部和周围正常胰腺实质的显影时间、达到峰值强度时间的比较,78.6%的胰腺癌显示为慢进快出型,而胰腺内分泌肿瘤均为快进快出型.8例胰腺囊性病变的PI值为0.181±0.036,且内部无血流信号强弱变化趋势.结论造影增强EUS对胰腺病变的定量分析为基于EUS影像的胰腺病变鉴别诊断提供了更为客观的依据,有望成为一种新的EUS下胰腺病变鉴别诊断的影像学手段.
목적 통과정량분석조영제증강후EUS영상적불동특정,위이선병변적영상감별진단제공객관의거.방법 대32례림상혹기타영상검사의유혹학진이선량、악성점위병변、만성이선염적환자이급19례인기타상소화도원인행EUS검사적이선정상환자위검사대상,관찰조영증강EUS검사시감흥취구역적혈류관주증강특정,동시사용조영분석연건진행정량분석.이EUS인도하세침천자세포학화(혹)조직병이학결과、수술병리결과위최종진단.결과 조영증강EUS후정량분석현시,19례정상이선적봉치강도(PI)치위0.648±0.174,통과비교,발현기여이선암화이선낭성병조적PI치지간적차이구통계학의의,차통과ROC곡선득출정상이선여이선암지간PI치적최가진단림계치위0.505,진단민감도、특이도분별위100.0%、84.2%.6례만성이선염PI치교대,위0.772±0.106.재이선점위성병조중,이선암여이선낭성병조급이선내분비종류지간PI치적차이역구통계학의의,차통과ROC곡선득출이선암여이선낭성병조지간PI치적최가진단림계치위0.195,진단민감도、특이도분별위85.7%、87.5%.14례이선암적PI치위0.321±0.119,4례이선내분비종류적PI치위0.763±0.115.통과병조내부화주위정상이선실질적현영시간、체도봉치강도시간적비교,78.6%적이선암현시위만진쾌출형,이이선내분비종류균위쾌진쾌출형.8례이선낭성병변적PI치위0.181±0.036,차내부무혈류신호강약변화추세.결론 조영증강EUS대이선병변적정량분석위기우EUS영상적이선병변감별진단제공료경위객관적의거,유망성위일충신적EUS하이선병변감별진단적영상학수단.
Objective To provide an objective basis for differential diagnosis of pancreatic diseases through quantitative analysis of the different features of contrast-enhanced endoscopic ultrasonography (CE-EUS). Methods A total of 32 patients with suspected or confirmed pancreatic neoplasms or chronic pancreatitis and 19 patients who underwent EUS due to other digestive problems other than pancreatic disease were enrolled. Features of blood perfusion of the regions of interest during CE-EUS were analyzed quantitatively. The findings were compared with cytological and/or histopathological results of EUS-FNA and/or surgery.Results Quantitative analysis of CE-EUS showed peak intensity (PI) value of 19 normal pancreas was 0.648 ±0. 174, which was statistically different from that of pancreatic cancer and pancreatic cystic lesions. Based on ROC, the cutoff of differential diagnosis was 0. 505, and the sensitivity and specificity were 100. 0% and 84. 2%, respectively. PI value of 6 chronic pancreatitis was the highest (0. 772 ±0. 106). In pancreatic neoplams, PI values of pancreatic carcinoma, pancreatic cyst and pancreatic endocrine tumors were significantly different. Based on a cutoff of 0. 195, the sensitivity and specificity of differentiation of pancreatic carcinoma and pancreatic cyst were 85.7% and 87.5%, respectively. PI value of 14 pancreatic carcinoma and that of 4 pancreatic endocrine tumors were 0. 321 ± 0. 119 and 0. 763 ± 0. 115, respectively. Through the comparison between the AT and TTP of the focal lesions and surrounding pancreatic parenchyma, 78.6% pancreatic carcinoma showed slow falling-in and rapid wash-out and all the endocrine tumors showed rapid falling-in and rapid wash-out. The PI value of 8 patients with pancreatic cyst was 0. 181 ±0. 036, with no enhanced blood flow in the cyst. The TIC was a straight line. Conclusion CE-EUS with quantitative analysis is a promising method that can be a more objective basis in the differential diagnosis of pancreatic diseases.