造影增强超声内镜检查对胰腺占位病变的鉴别诊断初步探讨

Contrast enhanced EUS in differential diagnosis of pancreatic tumor

目的探讨造影增强EUS在胰腺占位病变鉴别诊断中的应用价值。方法选择18例临床疑有胰腺占位病变或慢性胰腺炎的患者为检查对象，以内镜超声引导下细针穿刺细胞和（或）组织病理学结果为最终诊断，另选择5例正常胰腺作为对照，观察不同胰腺组织造影增强EUS检查下目标区域形态、内部回声及血流灌注的增强特征。结果造影增强EUS显示，5例正常胰腺实质呈均匀分布的点状或棒状彩色血流信号（Ⅰ、Ⅱ型）；而2例慢性胰腺炎患者的胰腺实质呈棒状或斑块状彩色血流信号，且分布不均匀（Ⅱ、Ⅲ型）。13例胰腺癌病变内部均呈少量点状或棒状增强（Ⅰ、Ⅱ型），部分肿块伴周边局部增强血流信号，且大部分呈慢进快退型；而3例胰腺良性占位胰岛细胞瘤病灶内部则呈整体斑块状明显增强（Ⅲ型），其中有2例呈快进快退型。此外，正常胰腺及各类胰腺疾．病的增强强度也呈不同等级。结论造影增强EUS诊断技术安全、可行，正常胰腺及不同胰腺疾病之间可显示不同的增强模式、时相特点及增强强度分级，为胰腺病变的鉴别诊断提供了一种新的影像学手段。

Objective To evaluate contrast-enhanced endoscopic ultrasonography（CE-EUS） in the differential diagnosis of pancreatic diseases. Methods Eighteen patients with suspected pancreatic neoplasms and chronic pancreatitis, which would be finally affirmed with EUS-FNA or histophathologic examina- tions, as well as five normal control subjects were enrolled and underwent CE-EUS by using ultrasonic con- trast agent （sonovue ,Bracco Co. ,Italy）. Characteristics of enhancement including form, echo and enhanced blood perfusion of the target areas were investigated in normal pancreas and various diseased ones. Results By CE-EUS, five cases of normal pancreatic parenchyma were presented as punctiform or claviform enhance- ment pattern with homogeneous distribution（ typeⅠ-Ⅱ ） ;while two chronic pancreatitis cases were presented as claviform or plaquelike enhancement pattern with inhomogeneous distributition（ typeⅡ-Ⅲ）. In addition, thirteen pancreatic carcinomas were presented as inhomogeneous punctiform or claviform enhancement（ typeI- Ⅱ ） partially with border enhancement and with slow enterin and fast wash-out phase. However, three benign insulinomas were presented as holo-plaquelike enhancement（ type Ⅲ ）, and 2 with fast enter-in and fast washout phase. Besides , different enhancement intensity was identified in different diseases. Conclusion CEEUS, from which different enhancement pattern, phase and intensity would be shown in various pancreas, is a safe and feasible imaging modality in the differential diagnosis of pancreatic diseases.