超声造影对胰腺囊实性病变的诊断及临床价值

Diagnosis and clinical value of pancreatic cystic and solid diseases by contrast-enhanced ultrasound

目的探讨超声造影对胰腺囊实性病变的诊断及临床价值。方法回顾性分析27例胰腺囊实性占位性病变的超声造影表现,术前评估胰腺肿瘤的可切除性,并与手术探查及病理结果对照。结果依据超声造影的增强程度与方式,若以增强期回声低于胰腺实质、减退期呈低回声作为诊断胰腺恶性肿瘤的依据,其诊断的敏感度、特异度和准确性分别为80.0%(8/10)、88.2%(12/13)和85.2%(23/27)。若以包括囊壁与分隔的实质部分的增强高或等于胰腺实质、与胰腺同步减退呈等回声为胰腺囊腺瘤的诊断标准,其诊断的敏感度、特异度和准确性分别为72.7%(8/11)、92.3%(12/13)和83.3%(20/24)。对14例恶性病例,术前超声造影判断可根治性切除6例,实际根治性手术切除8例。结论不同的胰腺囊实性病变超声造影表现各异,超声造影对胰腺囊实性病变鉴别及术前评估具有一定的价值。

Objective To investigate the value of contrast-enhanced ultrasound （CEUS） in diagnosis of pancreatic cystic and solid diseases. Methods Twenty-seven cases of pancreatic cystic and solid diseases were retrospectively analyzed. All the patients were examined by CEUS and the resectability of pancreatic tumors was preoperatively assessed. The results were compared with surgical and pathological examination. Results The hypo-enhancement of pancreatic tumors relative to pancreatic parenchyma by CEUS was used as evidence for pancreatic carcinoma, the sensitivity, specificity and accuracy of CEUS were 80.0%（8/10）, 88.2%（12/13） and 85.2%（23/27）, respectively. The hyper-enhancement or iso-enhancement in the capsule walls and septations by CEUS were used as evidence for pancreatic cystadenoma. The sensitivity, specificity and accuracy were 72.7%（8/11）, 92.3%（12/13） and 83.3%（20/24）, respectively. Among 14 cases of malignant tumors, 6 cases were to be resectable by CEUS before operation, and 8 cases received radical operations in the end. Conclusion Different pancreatic cystic and solid diseases show different enhancement patterns by CEUS, which may be of value in diagnosis and assessment of the pancreatic cystic and solid diseases before operation.