超声造影对胰腺占位病变的诊断应用价值

The role of contrast-enhanced ultrasound in diagnosing pancreatic diseases

目的观察胰腺占位病变超声造影灌注特征,比较超声造影及其他方法对胰腺良恶性病变的诊断价值。方法81例临床或超声、CT疑诊胰腺占位性病变行实时灰阶谐波造影(CEUS),其中经手术或临床资料、随访证实并明确诊断的72例胰腺占位性病变为重点研究对象。超声造影剂采用SonoVue,观察良性病变、恶性病变、非肿瘤区域胰腺实质CEUS的增强时相和模式。结果最终确诊良性病变18例,恶性病变54例,正常胰腺实质72例,三组间增强时相有差异。恶性病变造影开始增强时间晚于胰腺实质,开始减退时间早于胰腺实质,渡越时间短于胰腺实质及良性病变。良性病变与胰腺实质各时相无明显差异。造影剂增强模式恶性病变多为肿瘤周边增强、内部有不规则无增强区;良性病变多呈均匀整体增强。本组良恶性病变CEUS、增强CT、穿刺活检诊断正确率分别为87.5%(63/72例)、81.8%(54/66例)、95.1%(39/41例),均与常规超声的56.9%(41/72例)差异有统计学意义。结论CEUS能够提供更多的血流灌注特征,为胰腺病变的诊断及鉴别诊断提供参考依据,诊断率与增强CT相近,有较高的临床应用价值。

Objective To observe the enhancement patterns of pancreatic diseases and evaluate the role of contrast-enhanced ultrasound （CEUS） in diagnosing pancreatic diseases compared with conventional ultrasound, contrast-enhanced CT （CECT） and biospy. Methods Eight-one patients with pancreatic diseases underwent CEUS using SonoVue. Of them,72 patients with final diagnosis including 54 malignant and 18 benign cases were enrolled. The time of the beginning of enhancement, peak enhancement, the beginning of wash-out and the transit time （from the beginning of enhancement to wash-out） of the diseased area and normal pancreatic tissue were analyzed for each case. Results The beginning of enhancement of malignant pancreatic diseases was significantly slower than normal pancreatic tissue and the beginning of wash-out time was significantly faster than normal pancreatic tissue, while there was no significant difference between benign pancreatic diseases and normal pancreatic tissue. The transit time of malignant diseases was significantly shorter than benign diseases and normal pancreatic tissue. The most common enhancement pattern of malignant diseases was peripheral enhancement with irregular non-enhanced area inside,while the benign diseases appeared homogeneous enhancement. The diagnostic accuracy of CEUS, CECT and biopsy in pancreatic diseases characterization was 87.5 % （63/72 cases） ,81.8 % （54/ 66 cases）, 92.7% （38/41 cases）, respectively, which were all significantly different from that of conventional ultrasound （56. 9%, 41/72 cases）. Conclusions CEUS can afford more information of the vascularization of pancreatic diseases, thus improve the diagnostic ability in pancreatic diseases characterization. The diagnostic accuracy of CEUS is similar to CECT.