胰腺局灶性病变的超声造影表现及与微血管密度的相关性

Contrast-enhanced ultrasonographic appearance of focal lesions of pancreas and the correlation with microvascular density

目的探讨胰腺局灶性病变(FLPs)的增强超声(CEUS)造影模式及定量参数特征,分析定量参数与病灶微血管密度的相关性。方法对26例疑有胰腺占位的患者进行CEUS检查。分析不同病理类型FLPs的造影表现,并定量分析病灶的始增时间、达峰时间及峰值强度,计算始增-峰值时间进行分析。对病灶组织切片进行免疫组化标记CD34,计数病灶组织的MVD,分析病灶MVD与TIC定量参数间的相关性。结果在CEUS中,胰腺腺癌多呈低增强,胰腺内分泌肿瘤呈高增强,胰腺实性假乳头状瘤表现为周边环状等增强及内部不均匀增强。用低增强模式诊断胰腺腺癌的敏感性为85.71%,特异性为100%,阳性预测值100%,阴性预测值80.00%,准确性为90.91%。恶性组病灶与正常胰腺实质的平均始增-峰值时间比较差异有统计学意义(P<0.01)。病灶的峰值强度与MVD呈显著正相关(r=0.75,P<0.01)。结论不同病理类型FLPs的CEUS增强表现不同,CEUS能评价病灶的血管生成情况,在病灶的分期及预后评估上有很好的应用前景。

Objective To investigate the enhancement pattern and characteristics of parameters of focal lesions of pancreas（FLPs）in contrast enhanced ultrasound（CEUS）,and to analyze the correlation between CEUS parameters and microvascular density（MVD）of FLPs.Methods Twenty-six patients suspected with FLPs underwent CEUS.The characteristics in CEUS and parameters of time intensity curve（TIC）for FLPs,including arrival time,time to peak,peak intensity and the arrival-peak time,were analyzed.The lesions were histopathological examinated with CD34 markers to evaluate MVD.The correlation of the TIC parameters with the MVD for lesions was analyzed.Results In CEUS,most of the pancreatic carcinomas showed hypoenhancement,the pancreatic endocrine tumor presented hyperenhancement,the pancreatic solid pseudo-papillary tumor showed isoenhancement ring and mixed enhancement inner with non-enhancement areas.Taking hypoenhancement as a diagnosis indicator,the sensitivity,specificity,positive predictive value,negative predictive value and accuraty were 85.71%,100%,100%,80.00% and 90.91%,respectively for pancreatic carcinomas.There was statistical significance of mean arrival-peak time between malignant tumors and normal pancreas（P〈0.01）,while dominant positive correlation was found between peak intensity in TIC and MVD for FLPs（r=0.75,P〈0.01）.Conclusion The enhanced appearance in CEUS ares is helpful to the differential diagnosis of FLPs.CEUS can reflect the microcirculation infusion to evaluate the angiogenesis of FLPs.