胰腺转移癌超声造影表现探讨

Investigation of the manifestation of pancreatic metastases on contrast-enhanced ultrasound

目的探讨胰腺转移癌的超声造影表现特点。方法回顾性分析11例经病理或CT、MRI等增强影像学检查及临床综合诊断的胰腺转移癌病例，观察病变常规超声表现，超声造影增强与消退速度、强化程度及强化特点。结果11例胰腺转移癌原发于肺癌6例，乳腺癌1例，肾透明细胞癌1例，胃癌1例，直肠癌1例，子宫平滑肌肉瘤1例。病灶大小2．0～5．0cm，常规超声多表现为低回声病灶（8／11），8例为单发，3例为多发；常规超声3例诊断倾向或不除外胰腺转移癌，1例倾向恶性，余7例性质待定。超声造影增强早期2例（18．2％）呈高增强，6例（54．5％）呈等增强，3例（27．3％）呈低增强；增强晚期病灶多早于胰腺廓清而呈低增强（9／11）。胰腺转移癌多表现为整体均匀团状强化（7／11）。超声造影6例诊断胰腺转移癌，3例诊断为恶性，1例诊断神经内分泌肿瘤，1例性质待定。结论胰腺转移癌的超声造影表现有别于胰腺原发癌，重视原发癌的病史、超声造影增强早期表现特点等，有助于胰腺转移癌的诊断。

Objective To explore the manifestation of pancreatic metastases （PM） using contrast- enhanced ultrasound （CEUS）. Methods Eleven patients with PM confirmed by pathology or CT/MR1 combined with clinical data were analyzed retrospectively.The manifestation on conventional ultrasound and the enhancement appearance on CEUS were analyzed.Results The primary malignant tumors included lung cancer （ n = 6）, breast cancer （ n = 1 ）, renal clear cell carcinoma （ n = 1 ）, gastric cancer （ n = 1 ）, rectal cancer （n = 1） and leiomyosarcoma of uterus （n = 1 ）. Eight patients had one lesion and three were multiple.The maximum lesion diameter was 2.0- 5.0 cm. Eight of the 11 patients showed hypoechoic on conventional US.Three patients were diagnosed as probably PM, one probably malignant and 7 undetermined by US.In the early stage of CEUS, two patients showed hyper-enhancement, six showed iso-enhancement and 3 showed hypo-enhancement.In the late stage of CEUS, nine patients （9/11） showed hypo-enhancement. Seven patients showed homogeneous enhancement.Six patients were diagnosed as PM, three malignant, one neuroendocrine tumor and one undetermined by CEUS.Conclusions PM showed certain characteristics on CEUS.The hyper- or iso-enhancement at the early stage of CEUS and history of primary cancer is helpful for diagnosis of PM.