超声内镜与B超诊断胰腺疾病的对比分析

目的探讨超声内镜(EUS)和B超对胰腺疾病的诊断价值.方法对1999年6月至2001年6月期间123例胰腺疾病患者行EUS检查并与体表B超检查结果进行比较.结果 63例胰腺癌、45例胰腺炎和11例其它胰腺疾病患者经EUS确诊.38例胰腺癌,28例胰腺炎和5例其它胰腺疾病经US确诊.EUS诊断胰腺疾病的敏感性与准确性均明显高于B超,EUS与B超诊断符合率分别为96.7%(119/123)与56.9%(70/123)(P < 0.01).结论 EUS在胰腺疾病诊断中有较高的特异性和准确性,与B超联合应用有助于胰腺疾病的诊断.     

内镜超声对胰腺癌的诊断

目的 探讨内镜超声（EUS）检查对胰腺癌的诊断价值。方法 对116例胰腺癌患者行EUS检查，其中16例经管内超声（IDUS）检查并与体表B超（B超），CT，磁共振成像（MRI），内镜逆行胰胆管造影（ERCP）检查结果进行比较。结果 EUS（IDUS)诊断胰腺癌的敏感性与准确性均明显高于B超，与CT，MRI及ERCP相当，EUS诊断准确率为98．2％（114／116），IDUS为100％（16／16）；CT为85．3％（99／116）；MRI为87．0％（54／62）；ERCP为80．6％（79／98）；B超为73．2％（85／116）。结论 EUS对胰腺癌有较大的诊断价值。     

内镜超声诊断胰腺癌的准确性评价

目的 通过回顾性研究,评价内镜超声检查术(EUS)诊断胰腺癌的准确性,并分析EUS 评价胰腺癌的肿块大小、TNM分期和EUS引导下进行胰腺占位性病变穿刺的价值。方法 总结北京 协和医院1997年至2003年行EUS且资料完整的病例资料,其中胰腺癌88例(病理确诊56例,手术 诊断10例,临床诊断22例),胰腺良性疾病47例。结果 EUS鉴别胰腺癌和胰腺良性疾病的敏感性 95.50％(84／88)、特异性59.6％(28／47)、准确性83.0％(112／135),阳性预测值81.6％(84／103),阴 性预测值87.5％(28／32) EUS描述的胰腺癌肿块直径(2.8±1.0)cm,明显小于手术探查发现的肿 块直径(6.5±2.9)cm。在对肿瘤TNM分期评价中,EUS与手术探查结果比较,对T分期判断的符合 率43.1％,对N分期判断的符合率为61.1％。EUS引导胰腺占位性病变穿刺活检细胞学检查的成功 率89.5％,诊断准确率76.5％(13／17)。 结论 EUS诊断胰腺癌的敏感性高,EUS对胰腺癌肿块大小 的判断偏小。     

谐波造影增强超声内镜技术在胰腺占位性疾病中的诊断作用研究

目的探讨谐波造影增强超声内镜技术（CEH—EUS）在胰腺占位性疾病中的诊断作用。方法选择胰腺疾病患者为检查对象,以EUS—FNA或组织病理学结果以及随访结果为最终诊断,评价CEH—EUS诊断胰腺疾病的准确性,并分析CEH—EUS检查下受检部位的增强情况,包括增强顺序、增强时向特点、增强模式分级以及静脉洗脱程度。结果共23例胰腺疾病患者入选本研究,经FNA和（或）组织病理确诊,13例为胰腺癌,7例为慢性胰腺炎,2例为胰管内乳头状产黏蛋白肿瘤,1例为胰腺微囊型浆液性囊腺瘤。CEH—EUS诊断准确率为95．65％,明显高于普通EUS诊断准确率（78．2％）。其中CEH—EUS显示13例胰腺癌病灶增强晚于周围组织或与周围组织同步,呈不均匀低增强或存在充盈缺损区域,无显著达峰表现,消退明显早于周围组织。慢性胰腺炎等良性胰腺疾病病灶处增强与周围组织基本同步,充盈均匀,消退与周围组织同步。结论CEH—EUS在胰腺疾病的诊断中可以安全、简便、准确地显示病灶血供情况,不仅可成为EUS—FNA的有力补充,同时为胰腺疾病的鉴别诊断提供了直接且有效的帮助。     

内镜超声及其引导下的细针穿刺活检在胰腺疾病中的诊断价值

目的:探讨内镜超声(EUS)及其引导下的细针穿刺活检(EUS-FNA)在胰腺疾病诊断中的价值.方法:回顾性分析2008-03/2010-03经EUS检查的62例胰腺疾病,其中有32例行细针穿刺活检.结果:(1)62例胰腺疾病中胰腺癌26例、慢性胰腺炎20例、胰腺囊肿10例、胰岛细胞瘤2例;(2)B超、CT、EUS/EU...     

超声内镜对胆胰疾病诊断价值的探讨

目的 探讨超声内镜（EUS）对胆胰疾病的诊断价值。方法 采用超声胃镜（频率为7．5MHz和20Mnz），应用水囊法结合水充盈法，对54例临床疑为胆胰病变的患者进行EUS检查，并与腹部B超、CT及ERCP比较。结果 EUS、US、CT、ERCP对胆胰疾病诊断的阳性率分别为92．6％（50/54）、57．4％（31／54）、64．8％（35／54）及76．2％（32／42）。EUS对胰腺癌诊断的阳性率达100％。高于腹部B超、CT及ERCP；EUS对胆总管结石及慢性胰腺炎的准确率分别为100％和88．9％。结论 EUS对胆胰疾病的诊断率高于腹部B超，CT及ERCP影像检查，尤其对胆管扩张病因的定位及定性诊断均有较大的诊断价值。     

内镜超声检查术对胰腺肿瘤早期诊断的价值

目的探讨内镜超声检查术（EUS）、管内超声检查术（IDUS）及超声内镜引导下细针穿刺术（EUS-FNA）对胰腺肿瘤早期诊断的价值。方法回顾性分析和比较188例胰腺小占位病灶的EUS、IDUS、EUS—FNA及其他影像学检查结果。结果（1）EUS诊断小胰腺癌的准确率是95．6％（44／46）,优于B超58．6％（27／46）、CT77．4％（24／31）、MRI76．2％（16／21）及内镜逆行胰胆管造影术（ERCP）85．3％（29／34）。小胰腺癌EUS声像图主要表现为类圆形、边界清楚、边缘不规则的低回声肿块,内部回声多均匀。（2）25例胰腺小占位病灶行IDUS检查,其准确率是100．0％（25／25）,明显优于B超32．0％（8／25）、CT52．9％（9／17）及MRI57．9％（11／19）等检查。（3）18例胰腺小占位病灶行EUS—FNA,其准确率是66．7％（12／18）。（4）EUS诊断胰腺假性囊肿的准确率是100．0％（27／27）,明显优于13超52．0％（13／25）、CT66、7％（12／18）、MRI82．4％（14／17）及ERCP78．9％（15／19）;对胰腺囊性肿瘤分类鉴别诊断总的准确率是57．7％（15／26）,优于B超19．2％（5／26）、CT36．4％（8／22）、MRI37．5％（6／16）及ERCP50．0％（7／14）等检查。结论EUS、IDUS及EUS-FNA对胰腺肿瘤的早期诊断具有重要价值。     

胰腺结石的超声内镜检查和ERCP的对比研究

目的 探讨胰腺结石的EUS和ERCP表现及其诊断价值。方法 分析经手术或内镜下胰管取石确诊35例胰腺结石患的EUS和ERCP检查结果。结果 35例中ERCP诊断27例(78．3％)，8例诊断不明。伴有胰实质结石的4例患ERCP均未能对胰实质结石做出诊断。而EUS诊断33例(94．3％)，其中4例胰实质结石全部显示，2例胰管小结石未能诊断，EUS和ERCP联合检查全部35例均获得诊断。结论 ERCP联合EUS可提高胰腺结石诊断的准确率。     

内镜超声引导细针穿刺对胰腺癌的诊断价值

目的了解内镜超声(EUS)引导细针穿刺(FNA)对胰腺癌的临床价值及安全性。方法选择临床诊断或临床及影像学疑诊胰腺癌患者共21例,男13例,女8例,平均年龄(59.8±15.3)岁。EUS发现病变后,在实时超声引导下用超声穿刺针行FNA,对3例无法手术的胰腺癌患者行FNA同时,以无水乙醇阻滞腹腔神经丛治疗癌痛。结果B超共检出胰腺占位16例(16/21),未检出的5例中3例经CT检出,CT共检出胰腺占位19例;EUS检出全部21例胰腺占位,5例位于胰体尾,16例位于胰头。18例患者EUS-FNA获满意标本,17例诊断为胰腺癌,1例诊断为慢性胰腺炎,胰腺癌诊断敏感性为85.0%、特异性为100.0%、准确度为85.7%。3例行无水乙醇阻滞后疼痛减轻。术后发生轻度胰腺炎1例、发热1例。结论EUS能有效检出胰腺占位,结合FNA可提高诊断的特异性及准确性。     

内镜超声检查对胰腺癌可切除性的评估

目的：应用内镜超声检查术(EUS)对胰腺癌的可切除性进行前瞻性评估。方法：对初步诊断为胰腺癌的患者进行术前EUS，由2位内镜超声专家进行术前可切除性评估，以手术结果作为金标准进行对比，并与CT、MRI、B超诊断结果进行比较。结果：38例接受了手术治疗，其中10例术前EUS认为可切除，实际术中切除8例，EUS评估胰腺癌可切除性的准确度为80．0％；28例术前EUS评估为不可切除，实际手术无法切除27例，EUS评估不可切除准确度为96．4％。提示EUS术前评估结果与手术结果一致性较好。EUS诊断胰腺癌准确率为97．4％，CT为94．6％，MRI为89．5％．B超为73．7％。结论。应用EUS评估胰腺癌的可切除性是一种有效的方法。     

胰腺炎并发假性动脉瘤11例临床分析

目的分析判断胰腺假性动脉瘤适合的临床诊断及治疗方法。方法回顾我院2006年1月至2014年12月间收治的11例胰腺假性动脉瘤患者临床资料,包括诊断、治疗方式及临床效果。结果胰腺假性动脉瘤的诊断方式为经内镜超声诊断2例,经腹部增强CT诊断8例,经介入造影诊断1例。10例患者接受经动脉介入栓塞治疗,9例治疗成功,随访28 d时,1例患者再次出血,经二次栓塞治疗成功止血;1例患者成功接受手术治疗。结论腹部增强CT及动脉造影是诊断胰腺假性动脉瘤的主要方法,内镜超声也可用于诊断。手术治疗是胰腺假性动脉瘤的传统治疗方式,介入栓塞治疗逐渐成为治疗胰腺假性动脉瘤的首选治疗方式。但为进一步明确胰腺假性动脉瘤的诊疗方案,仍需大样本的临床观察。     

内镜超声检查对胆囊癌的诊断价值

目的探讨内镜超声检查(EUS)对胆囊癌的诊断价值.方法对18例胆囊癌患者行EUS检查并与体表B超(B超),X线电子计算机断层扫描(CT)/磁共振成像(MR1)结果进行比较.结果18例中,EUS诊断17例,CT/MRI诊断15例,B超诊断5例.EUS诊断胆囊癌的敏感性与准确性高于B超,与CT/MRI相当.13例行手术治疗,与手术病理比较,EUS诊断正确率为92%,CT/MRI为76.9%(P＞0.05),B超为41.6%(P＜0.01).EUS对小病灶的显示明显优于B超,并优于CT/MRI.结论EUS对胆囊癌有较高的诊断价值.     

Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound for diagnosis of chronic pancreatitis

The diagnosis of chronic pancreatitis is based on altered pancreatic morphology and function. A spectrum of disease exists, and milder forms of disease may be missed by CT but demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS). The accuracy of ERCP and EUS for diagnosis of “minimal change” or “early” chronic pancreatitis is controversial, particularly when the results from these imaging procedures are discordant with each other or with tests of pancreatic function; in some cases ERCP and EUS should be considered indeterminate for diagnosis. This review discusses recent data concerning the accuracy of ERCP and EUS for diagnosis of chronic pancreatitis, the use of EUS fine-needle aspiration for differential diagnosis of pancreatic masses, and the use of EUS and EUS-guided TruCut biopsy for diagnosis of autoimmune pancreatitis.     

Mass-forming pancreatitis： Value of contrast-enhanced ultrasonography

AIM: To assess the utility of contrast-enhanced ultrasonography (CEUS) with a second-generation contrast medium in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma. METHODS: From our radio-pathology database, we retrieved all the patients affected by mass-forming pancreatitis or pancreatic carcinoma who underwent CEUS. We evaluated the results of CEUS in the study of the 173 pancreatic masses considering the possibilities of a differential diagnosis between mass-forming pancreatitis and pancreatic tumor by identifying the "parenchymographic" enhancement during the dynamic phase of CEUS, which was considered diagnostic for mass-forming pancreatitis. RESULTS: At CEUS, 94% of the mass-forming pancreatitis showed intralesional parenchymography. CEUS allowed diagnosis of mass-forming pancreatitis with sensitivity of 88.6%, specificity of 97.8%, positive predictive value of 91.2%, negative predictive value of 97.1%, and overall accuracy of 96%. CEUS significantly increased the diagnostic confidence in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma, with receiver operating characteristic curve areas from 0.557 (P = 0.1608) for baseline US to 0.956 (P < 0.0001) for CEUS. CONCLUSION: CEUS allowed diagnosis of mass-forming pancreatitis with diagnostic accuracy of 96%. CEUS significantly increases the diagnostic confidence with respect to basal US in discerning mass-forming pancreatitis from pancreatic neoplasm.     

胰管内超声在鉴别胰腺癌和慢性胰腺炎中的临床应用价值

目的与常规影像学检查对比,评价胰管内超声对胰腺癌和慢性胰腺炎的诊断价值;方法对１８例经手术证实和临床诊断为胰癌和慢性胰腺炎的患者行胰管内超声检查,且与常规腹部超声、计算机断层扫描、逆行胰胆管造影作比较;结果胰管内超声对胰癌和慢性胰腺炎的诊断符合率明显优于常规影像学检查;结论胰管内超声在胰癌和慢性胰腺炎的临床鉴别诊断中是一种可行且有效的检查方法。     

Utility of fusion CT-PET in the diagnosis of small pancreatic carcinoma

Pancreatic carcinoma has a poor prognosis and early detection is essential for potentially curative resection. Despite the wide array of diagnostic tools, preoperative detection of small pancreatic carcinomas remains difficult. We report a case of small pancreatic carcinoma of the head of pancreas with indeterminate findings on US, ERCP, MRI and EUS which was successfully diagnosed via fusion CT-PET. This case illustrates the utility of CT-PET in the diagnosis of patients with small pancreatic carcinoma with equivocal findings on conventional diagnostic modalities.     

超声内镜对慢性胰腺炎的诊断价值

目的：探讨超声内镜（EUS）对慢性胰腺炎的诊断价值。方法：对46例慢性胰腺炎患者进行EUS检查,并与体表超声（US）和内镜逆行胰胆管造影（ERCP）结果作比较。结果：EUS诊断慢性胰腺炎的敏感性和准确性均显著高于US和ERCP,其诊断符合率达91．3％,亦显著高于US（45．7％）和ERCP（58．7％）（P＜0．01）。结论：EUS对慢性胰腺炎有较高的诊断价值。     

Diagnosis of pancreatic cancer

The ability to diagnose pancreatic carcinoma has been rapidly improving with the recent advances in diagnostic techniques such as contrast-enhanced Doppler ultrasound (US), helical computed tomography (CT), enhanced magnetic resonance imaging (MRI), and endoscopic US (EUS). Each technique has advantages and limitations, making the selection of the proper diagnostic technique, in terms of purpose and characteristics, especially important. Abdominal US is the modality often used first to identify a cause of abdominal pain or jaundice, while the accuracy of conventional US for diagnosing pancreatic tumors is only 50-70%. CT is the most widely used imaging examination for the detection and staging of pancreatic carcinoma. Pancreatic adenocarcinoma is generally depicted as a hypoattenuating area on contrast-enhanced CT. The reported sensitivity of helical CT in revealing pancreatic carcinoma is high, ranging between 89% and 97%. Multi-detector-row (MD) CT may offer an improvement in the early detection and accurate staging of pancreatic carcinoma. It should be taken into consideration that some pancreatic adenocarcinomas are depicted as isoattenuating and that pancreatitis accompanied by pancreatic adenocarcinoma might occasionally result in the overestimation of staging. T1-weighted spin-echo images with fat suppression and dynamic gradient-echo MR images enhanced with gadolinium have been reported to be superior to helical CT for detecting small lesions. However, chronic pancreatitis and pancreatic carcinoma are not distinguished on the basis of degree and time of enhancement on dynamic gadolinium-enhanced MRI. EUS is superior to spiral CT and MRI in the detection of small tumors, and can also localize lymph node metastases or vascular tumor infiltration with high sensitivity. EUS-guided fine-needle aspiration biopsy is a safe and highly accurate method for tissue diagnosis of patients with suspected pancreatic carcinoma. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been suggested as a promising modality for noninvasive differentiation between benign and malignant lesions. Previous studies reported the sensitivity and specificity of FDG-PET for detecting malignant pancreatic tumors as being 71-100% and 64-90%, respectively. FDG-PET does not replace, but is complementary to morphologic imaging, and therefore, in doubtful cases, the method must be combined with other imaging modalities.     

超声内镜弹性成像在良恶性胰腺病变鉴别中的应用价值

目的:探讨超声内镜弹性成像(endoscopic ultrasound,EUS)在胰腺占位病变良恶性鉴别中的应用价值.方法:影像学结果并经超声内镜检查确定有胰腺占位性病变的患者入选,对目标病变行超声内镜弹性成像检查,按照弹性成像5分法对组织弹性成像进行评分,将弹性成像评分为12分归为良性,3-5分归为恶性病变.结果:自2009-06/2011-06,共27例符合标准的胰腺占位病变患者入选,其中胰腺癌19例,超声内镜弹性成像评分3分(n=11)、4分(n=5)、5分(n=3),无功能性良性内分泌肿瘤(4分)及低度恶性神经内分泌肿瘤(5分)各1例,炎性病变6例,评分1分(n=1)、2分(n=3)、3分(n=2).超声内镜弹性成像对27例胰腺占位病变良恶性鉴别中24例诊断准确,诊断灵敏度100%,特异度57.14%,阳性预测值86.96%,阴性预测值100%.结论:超声内镜弹性成像对胰腺良恶性病变的鉴别具有较高的准确性,可望为疾病诊断提供新的影像学手段,但其仍为一种影像学手段,具有一定的局限性,并不替代胰腺的细胞病理学检查.