超声造影表现在胰腺实性局灶性病变鉴别诊断中的意义

Role of Contrast-enhanced Ultrasound in the Differentiation of Solid Focal Lesions of Pancreas

目的探讨各种超声造影增强表现在胰腺实性局灶性病变(s-FLPs)鉴别诊断中的意义。方法回顾性分析56例确诊的s-FLPs的各种超声造影增强表现及其诊断效能,总结s-FLPs的重要增强特征,探讨超声造影表现的鉴别诊断意义。结果不同s-FLPs的实质始增时间、病灶始增时间和增强峰值时间比较差异无显著性(P>0.05),而病灶始增-峰值时间有较大的差异(P<0.05)。以增强速度快慢诊断胰腺癌和肿瘤性胰腺炎的敏感性、特异性、准确性分别为90.5%、71.4%、85.7%和75.0%、91.7%、89.3%。以增强模式诊断胰腺癌和肿瘤性胰腺炎的敏感性、特异性、准确性分别为85.7%、78.6%、83.9%和75.0%、100%、94.6%。增强模式的Youden指数最高。把不同的诊断指标进行组合后,增强模式与增强速度的组合诊断价值最高,但其Youden指数并没有得到提高。结论不同s-FLPs具有不同的增强表现,增强速度和增强模式的差异是鉴别诊断胰腺癌或肿瘤样胰腺炎的最重要诊断指标。

Objective To investigate the value of contrast-enhanced ultrasound in the differential diagnosis of solid focal lesions of pancreas （s-FLPs）. Methods We retrospectively analyzed the clinical data of 56 s-FLPs examined with contrast agent combined with low mechanical indicators contrast-enhanced ultrasound. Results The surrounding pancreas parenchyma enhancement time, lesion enhancement time, and peak enhancement time between different groups of s-FLPs had no significant differences （ P 〉 0.05 ） , while the beginning to peak enhancement time showed significant difference （ P 〈 0.05 ）. When using the enhancement speed as a diagnostic indicator to differentiate pancreatic carcinoma from tumor-like pancreatitis, the sensitivity, specificity, and accuracy were 90.5% , 71.4% , and 85.7% for pancreatic carcinoma and 75.0% , 91.7%, and 89.3% for tumor-like pancreatitis. When using the enhancement pattern as a diagnosis indicator to differentiate pancreatic carcinoma from tumor-like pancreatitis, the sensitivity, specificity, and accuracy were 85.7% , 78.6% , and 83.9% for pancreatic carcinoma and 75.0% , 100% , and 94.6% for tumor-like pancreatitis. When different indicators were combined, enhancement pattern and enhancement speed showed the best diagnostic results ; however, the Youden index was not improved. Conclusions Different s-FLPs show different enhancement findings on contrast-enhanced ultrasound. The enhancement pattern and enhancement speed are the most useful diagnostic indicators.