胰腺实性局灶性病变超声造影增强模式初探

目的 探讨各种胰腺实性局灶性病变(s-FLPs)超声造影增强模式.方法 采用SonoVue 结合低机械指数厌阶超声造影技术回顾性分析56例确诊的胰腺实性局灶性病变,观察不同胰腺实性局灶性病变在不同时相的增强特征.结果 胰腺癌85.7%(36/42)实质灌注早期和实质灌注晚期均保持低增强水平呈Ⅰ型增强模式,90.5%(38/42)增强晚于胰腺实质,血管期肿瘤内町见不规则分布的扭曲走行微血管缓慢由周边向中央灌注;肿瘤样胰腺炎75%(6/8)实质灌注早期和实质灌注晚期均保持等增强水平呈Ⅱ型增强模式,75%(6/8)与胰腺实质同时增强,血管期肿块内可见均匀分布的微血管快速全瘤灌注;胰腺内分泌肿瘤2/3呈实质灌注早期为高增强和实质灌注晚期为低增强呈Ⅳ型增强模式,2/3增强早于胰腺实质,血管期肿瘤内微血管快速伞瘤灌注;转移瘤增强模式与原发肿瘤类型有关,血管期肿瘤内微血管快速全瘤灌注.结论 不同胰腺实性局灶性病变的超声造影有其典型的增强模式,从而克服了BUS对s-FLPs缺乏组织特性的不足,有望成为s-FLPs鉴别诊断的一种重要影像学方法.

Initial study of contrast-enhanced ultrasonography for solid focal lesions in pancreas

Objective To investigate the enhancement patterns of different solid focal lesions of pancreas in contrast-enhanced uhrasonography.Methods The features of 56 solid focal lesions of pancreas in different phases confirmed by ultrasound contrast agent SonoVue combined with low mechanical index contrast-enhanced ultrasound technique were retrospectively analyzed to investigate the enhancement patterns of different lesions in different phases.Results A percentage of 85.7% (36/42) of the pancreatic adenocarcinoma was of the type Ⅰ pattern and 90.5% (38/42) of them enhanced later than the normal pancreatic parenchyma.In vascular phase,the irregular distributive and twist microvessels perfused from the margin to the center slowly.And 75% (8/8) of the tumor-like panereatitis was of the type Ⅱ pattern and 75% (6/8) of them enhanced simultaneously with the normal pancreatic parenchyma.In vascular phase,the regular distributive microvessels perfused from the margin to the center and achieved complete homogeneous perfusion of the whole lesions.The 2/3 neuroendocrine pancreatic tumors were of the type Ⅳ pattern and 2/3 of them enhanced quicker than the normal pancreatic parenchyma.In vascular phase,they achieved complete perfusion of the whole tumors very quickly.The enhancement patterns of pancreatic metastatic tumors were related to the primary tumors.Conclusion Different solid focal lesions of pancreas have their own typical enhancement patterns in contrast-enhanced uhrasonography. Contrast-enhanced uhrasonography may overcome the shortage of basic ultrasound and become an important means in the differential diagnosis.