造影增强超声内镜检查对胰腺占位病变的鉴别诊断初步探讨

目的 探讨造影增强EUS在胰腺占位病变鉴别诊断中的应用价值.方法 选择18例临床疑有胰腺占位病变或慢性胰腺炎的患者为检查对象,以内镜超声引导下细针穿刺细胞和(或)组织病理学结果为最终诊断,另选择5例正常胰腺作为对照,观察不同胰腺组织造影增强EUS检查下目标区域形态、内部回声及血流灌注的增强特征.结果 造影增强EUS显示,5例正常胰腺实质呈均匀分布的点状或棒状彩色血流信号(Ⅰ、Ⅱ型);而2例慢性胰腺炎患者的胰腺实质呈棒状或斑块状彩色血流信号,且分布不均匀(Ⅱ、Ⅲ型).13例胰腺癌病变内部均呈少量点状或棒状增强(Ⅰ、Ⅱ型),部分肿块伴周边局部增强血流信号,且大部分呈慢进快退型;而3例胰腺良性占位胰岛细胞瘤病灶内部则呈整体斑块状明显增强(Ⅲ型),其中有2例呈快进快退型.此外,正常胰腺及各类胰腺疾病的增强强度也呈不同等级.结论 造影增强EUS诊断技术安全、可行,正常胰腺及不同胰腺疾病之间可显示不同的增强模式、时相特点及增强强度分级,为胰腺病变的鉴别诊断提供了一种新的影像学手段.

Contrast enhanced EUS in differential diagnosis of pancreatic tumor

Objective To evaluate contrast-enhanced endoscopic uhrasonography(CE-EUS)in the differential diagnosis of pancreatic diseases.Methods Eighteen patients with suspected pancreatic neoplasms and chronic pancreatitis,which would be finally affirmed with EUS-FNA or histophathologic examinations,as well as five normal control subjects were enrolled and underwent CE-EUS by using ultrasonic contrast agent(sonovue,Bracco Co.,Italy).Characteristics of enhancement including form,echo and enhanced blood perfusion of the target areas were investigated in normal pancreas and various diseased ones.Results By CE-EUS,five cases of normal pancreatic parenchyma were presented as punctiform or claviform enhancement pattern with homogeneous distribution(type Ⅰ-Ⅱ);while two chronic pancreatitis cases were presented as claviform or plaquelike enhancement pattern with inhomogeneous distributition(type Ⅱ-Ⅲ).In addition,thirteen pancreatic carcinomas were presented as inhomogeneous punctiform or claviform enhancement(typeⅠ-Ⅱ)partially with border enhancement and with slow enter-in and fast wash-out phase.However,three benign insulinomas were presented as holo-plaquelike enhancement(type Ⅲ),and 2 with fast enter-in and fast washout phase.Besides,different enhancement intensity was identified in different diseases.Conclusion CEEUS,from which different enhancement pattern,phase and intensity would be shown in various pancreas,is a safe and feasible imaging modality in the differential diagnosis of pancreatic diseases.