超声造影对胰腺癌与肿块型胰腺炎的鉴别诊断价值

Differential diagnostic value of pancreatic cancer and mass pancreatitis by contrast-enhanced ultrasound

目的探讨超声造影对胰腺癌及肿块型胰腺炎的鉴别诊断价值,提高术前诊断符合率。方法选取我院经手术及病理确诊的胰腺癌患者32例(胰腺癌组)和肿块型胰腺炎患者28例(肿块型胰腺炎组),均行常规超声和超声造影检查,分析并比较两组超声造影时间-强度曲线各参数的差异;绘制常规超声和超声造影诊断胰腺良恶性肿块的受试者工作特征(ROC)曲线并计算其曲线下面积,比较两种检查方法对胰腺良恶性肿块的诊断效能。结果超声造影静脉相:胰腺癌组不均质增强比例为77.14%,高于肿块型胰腺炎组(35.71%),差异有统计学意义(P<0.01)。胰腺癌组上升时间、达峰时间、峰值强度分别为2.82 s、3.51 s、58.18 d B,与肿块型胰腺炎组(1.31 s、1.56 s、76.09 d B)比较,差异均有统计学意义(均P<0.05);平均渡越时间比较差异无统计学意义。常规超声诊断胰腺癌及肿块性胰腺炎的ROC曲线下面积为0.544,敏感性为60.07%,特异性为53.12%,诊断符合率为56.66%。超声造影诊断胰腺癌及肿块性胰腺炎的ROC曲线下面积为0.780,敏感性为80.00%,特异性为73.33%,诊断符合率为76.67%,两者比较差异均有统计学意义(均P<0.05)。结论超声造影对于胰腺癌及肿块型胰腺炎的诊断及鉴别诊断较常规超声更加准确和客观,有较高的临床应用价值。

Objective To investigate the value of contrast -enhanced ultrasound in differential diagnosis of pancreatic cancer and mass pancreatitis,and to improve the preoperative diagnostic accuracy. Methods Thirty-two patients with pancreatic cancer（pancreatic cancer group） and 28 patients with mass pancreatitis（mass pancreatitis group） were selected, all the patients were confirmed by surgery and pathology.Two groups were examined by conventional ultrasound and contrast-enhanced ultrasound,the differences of the parameters of time-intensity curve between two groups were analyzed and compared. The receiver operating characteristics（ROC） curve of conventional ultrasound and contrast-enhanced ultrasound in diagnosing benign and malignant pancreatic tumors were drew,and the area under the curve were calculated,the diagnostic efficacy of the two methods for detecting pancreatic masses were compared.Results Venous phase of contrast-enhanced ultrasound：pancreatic cancer group showed the proportion of inhomogeneous enhancement was 77.14%,which was higher than that in mass pancreatitis group（35.71%）,the difference was statistically significant（P〈0.01）.The AT,PI and TTP in pancreatic cancer group were 2.82 s, 3.51 s and 58.18 dB,and those in massive pancreatitis group were 1.31 s,1.56 s and 76.09 dB,the difference was statistically significant（all P〈0 . 05）, the difference of mTT was not statistically significant . The area under the ROC curve of conventional ultrasound diagnosis of pancreatic cancer and mass pancreatitis was 0.544,sensitivity was 60.07%,specificity was 53.12%,and the diagnostic coincidence rate was 56.66%.The area under the ROC curve of contrast-enhanced ultrasound diagnosis of pancreatic cancer and mass pancreatitis was 0.780,sensitivity was 80.00%,specificity was 73.33%,and the diagnostic coincidence rate was 76.67%,the difference was statistically significant（all P〈0.05）.Conclusion Compared with conventional ultrasound,contrast-enhanced ultrasound is more accurate and objective in the diagnosis and differential diagnosis of pancreatic cancer and mass pancreatitis,it has higher clinical value.