CAJ | 학술논문

目的探讨谐波造影增强内镜超声(CH-EUS)对胰腺癌与局灶型胰腺炎鉴别诊断的价值.方法选择上海长海医院经CH-EUS检查诊断为胰腺癌和局灶型胰腺炎患者,以内镜超声引导下细针穿刺术(EUS-FNA)或组织病理学及6个月以上随访结果作为最终诊断,评价CH-EUS对胰腺癌与局灶型胰腺炎的鉴别诊断效果,并分析两者的CH-EUS图像特征.结果共有56例患者入选本研究,平均年龄(56±12)岁.最终诊断局灶型胰腺炎21例,胰腺癌35例.CH-EUS显示的正常胰腺组织增强时相与周围组织同步,达峰显著,呈均匀等增强.胰腺癌增强时相多数晚于正常胰腺组织,消退快,达峰不显著,94.3％ (33/35)的病灶内部呈不均匀低增强,1例高增强者为癌肿内部有较多高强化的分隔,1例均匀等增强者为慢性胰腺炎癌变.局灶型胰腺炎增强多数表现为与正常胰腺组织等时相,达峰显著,76.2％(16/21)呈均匀等增强.CH-EUS鉴别局灶型胰腺炎与胰腺癌的灵敏度为90.5％,特异度97.1％,准确率94.6％,阳性预测值95.0％,阴性预测值94.4％,阳性似然比31.7,阴性似然比0.1.结论 CH-EUS可以实时、清晰地显示胰腺肿瘤的血供情况,能对胰腺癌和胰腺局灶型炎症的鉴别诊断提供有力帮助,是一种有价值的临床诊断新方法.
목적 탐토해파조영증강내경초성(CH-EUS)대이선암여국조형이선염감별진단적개치.방법 선택상해장해의원경CH-EUS검사진단위이선암화국조형이선염환자,이내경초성인도하세침천자술(EUS-FNA)혹조직병이학급6개월이상수방결과작위최종진단,평개CH-EUS대이선암여국조형이선염적감별진단효과,병분석량자적CH-EUS도상특정.결과 공유56례환자입선본연구,평균년령(56±12)세.최종진단국조형이선염21례,이선암35례.CH-EUS현시적정상이선조직증강시상여주위조직동보,체봉현저,정균균등증강.이선암증강시상다수만우정상이선조직,소퇴쾌,체봉불현저,94.3％ (33/35)적병조내부정불균균저증강,1례고증강자위암종내부유교다고강화적분격,1례균균등증강자위만성이선염암변.국조형이선염증강다수표현위여정상이선조직등시상,체봉현저,76.2％(16/21)정균균등증강.CH-EUS감별국조형이선염여이선암적령민도위90.5％,특이도97.1％,준학솔94.6％,양성예측치95.0％,음성예측치94.4％,양성사연비31.7,음성사연비0.1.결론 CH-EUS가이실시、청석지현시이선종류적혈공정황,능대이선암화이선국조형염증적감별진단제공유력방조,시일충유개치적림상진단신방법.
Objective To evaluate the efficacy of contrast-enhanced harmonic EUS (CH-EUS) in the differentiation of pancreatic cancer and focal pancreatitis.Methods Patients with a diagnosis of pancreatic cancer and focal pancreatitis by CH-EUS were enrolled.Final diagnosis was confirmed by EUS-FNA or histopathology and follow-up of 6 months.The efficacy of CH-EUS in the differentiation of pancreatic cancer and focal pancreatitis was determined,and the characteristics of CH-EUS images were analyzed.Results A total of 56 patients were enrolled,with an average age of (56 ± 12) years old.The final diagnosis as focal pancreatitis in 21 patients,pancreatic cancer in 35.Enhancement pattern of normal pancreas by CH-EUS was simultaneous with the adjacent tissues,with obvious peak and homogeneous isoenhancement.The timing of enhancement of most of pancreatic cancer by CH-EUS was later than the adjacent normal pancreatic tissue,with early subsidence and no obvious peak.Ninety-seven percent (34/35) malignant lesions were shown to have inhomogeneous hypoenhancement within the lesion,1 case had a homogeneous isoenhancement pattern which was diagnosed to have chronic pancreatitis with pancreatic cancer and 1 case had hyperenhancement separation in the center of the cancer.Enhancement of focal pancreatitis was simultaneous with the surrounding pancreatic tissues with obvious peak,76.2％ (16/21) of the inflammatory lesions were shown to have homogeneous isoenhancement.The sensitivity,specificity and accuracy of CH-EUS in the differentiation of pancreatic cancer and focal pancreatitis was 90.5％,97.1％ and 94.6％,positive and negative predictive value was 95.0％ and 94.4％,positive and negative likelihood ratio was 31.7 and 0.1.Conclusions CH-EUS can effectively realtime identify pancreatic cancer and focal inflammation by clearly showing the vascular structures,and can be used as a valuable new method for clinical diagnosis.