不同超声造影参数在胰腺原发性良恶性病灶鉴别诊断中的应用

目的 探讨不同超声造影参数及模式对胰腺原发性良恶性病灶的鉴别诊断价值,以期能为诊断提供参考.方法 选择2010年6月～2013年6月赤壁市人民医院常规超声、CT等检查初步拟诊为胰腺原发性占位性病变的患者64例,其中病理证实为原发性胰腺恶性病变者48例,良性病变者16例;回顾性分析患者的临床资料,分析超声造影检查参数在良恶性病灶间的差异性;比较超声造影下胰腺原发性良恶性病灶与正常胰腺组织时间-强度曲线的不同参数指标.结果 ①超声造影低增强模式下进行胰腺良恶性病变的诊断敏感性为100.00％（48/48）、特异性为50.00％ （8/16）、阳性预测值为85.71％（48/56）、阴性预测值为100.00％（8/8）;超声造影晚增强模式下进行胰腺良恶性病变的诊断敏感性为75.00％（36/48）、特异性为12.50％（2/16）、阳性预测值为94.74％（36/38）、阴性预测值为53.84％（14/26）.②时间-强度曲线参数比较：恶性病变相对上升时间、相对平均渡越时间、相对最高增强百分数为（-1.27±4.03）s、（6.37±18.37）s、（3.84±23.24）％,良性病变为（0.97±3.12）s、（-7.50±20.18）s、（-32.37±42.15）％,两者比较差异有统计学意义（t=2.03、2.55、4.33,P＜0.05）;相对达峰时间、相对到达时间恶性病变为（-1.10±4.80）s、（-0.61±5.31）s,良性病变为（1.73±6.86）s、（1.02±6.30）s,两者比较差异无统计学意义（t=1.83、1.01,P＞0.05）.结论 超声造影检查能通过观察时间-强度曲线参数对胰腺原发性占位病灶进行鉴别诊断,具有较高的临床应用价值.

Application value of different contrast-enhanced ultrasound paramenters in differential diagnosis of primary benign and malignant pancreatic lesions

Objective To discuss differential diagnosis value of different contrast-enhanced ultrasound paramenters and models in primary benign and malignant pancreatic lesions,in order provide a reference for diagnosis.Methods 64 cases of Primary pancreas space-occupying lesions diagnosed by conventional ultrasound or CT in People＇s Hospital of Chibi City from June 2010 to June 2013 were selected including 48 cases of primary pancreatic malignant lesions and 16 cases of benign lesion by pathology.Patients＇ clinical data were retrospective analyzed,contrast-enhanced ultrasound examination paramenters in the differences between benign and malignant lesions were compared; different contrast-enhanced ultrasound parameters of time-intensity curve between benign,malignant lesions and normal pancreatic tissue was compared.Results ①Pancreas benign and malignant lesions sensitivity,specificity,positive predictive value,negative predictive value were 100.00％ （48/48）,50.00％ （8/16）,85.71％ （48/56）,100.00％ （8/8） respectively under contrast-enhanced ultrasound low enhanced mode; Pancreas benign and malignant lesions sensitivity,specificity,positive predictive value,negative predictive value were 75.00％（36/48）,12.50％ （2/16）,94.74％ （36/38）,53.84％ （14/26） respectively under contrast-enhanced ultrasound late enhanced mode.②Malignant lesions relative rise time,the relative average transit time and enhancing the highest relative percentage were （1.27±4.03） s,（6.37±18.37） s,（3.84±23.24） ％ respectively,benign lesions were （0.97±3.12） s,（-7.50±20.18）,（-32.37±42.15） ％ respectively according to time intensity curve parameter comparison,the differences were statistically significant （t =2.03,2.55,4.33,P ＜ 0.05）.relative peak time,relative arrival time of malignant lesions were （-1.10±4.80） s,（-0.61±5.31） s,relative peak time,relative arrival time of benign lesion were （1.73±6.86） s,（1.02±6.30） s,the difference was not statistically significant （t =1.83,1.01,P ＞ 0.05）.Conclusion Contrast-enhanced ultrasound can differentially diagnose the pancreatic primary placeholder lesions through observed time-intensity curve,it has high clinical value.