谐波造影增强内镜超声对胰腺癌与局灶型胰腺炎的鉴别诊断价值

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.

Efficacy of contrast-enhanced harmonic endoscopic ultrasonography in the differentiation of pancreatic cancer and focal pancreatitis

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.