超声造影评估胰腺癌胰周动静脉侵犯的临床价值

Predictive value of contrast-enhanced ultrasound for peripancreatic vascular invasion in pancreatic carcinoma

目的评价超声造影(CEUS)诊断胰腺癌侵犯胰周动脉或静脉的临床应用价值。方法选取2013年1月至2017年3月在浙江大学医学院附属第二医院就诊的94例经手术病理证实的胰腺癌患者的超声造影资料,观察各病灶超声造影增强特征,判断病灶周围动静脉是否侵犯,并将超声诊断结果与术后病理作对比分析。胰周动脉受侵的CEUS诊断标准为动脉被肿瘤包埋或肿瘤包绕动脉且管壁浸润或管腔狭窄。胰周静脉受侵的CEUS诊断标准为肠系膜上静脉、门静脉被肿瘤包绕、狭窄、扭曲或闭塞。结果经手术病理诊断的94例胰腺癌患者,其中胰头癌62例,胰腺体尾部癌32例,超声造影6例(6.4%)表现为实质期不均匀高增强,78例(83%)表现为实质期呈不均匀低增强,10例(10.6%)表现为实质期不均匀等增强。CEUS诊断CA受侵25例(26.6%),未受侵69例(73.4%),其诊断的敏感度、准确性、特异度、阳性预测值、阴性预测值分别为63.6%、79.7%、84.7%、56.0%、88.0%。CEUS诊断肠系膜上动脉(SMA)受侵27例(28.7%),未受侵67例(71.3%),其诊断的敏感度、准确性、特异度、阳性预测值、阴性预测值分别为66.6%、77.6%、80.2%、44.0%、91.0%。CEUS诊断PV受侵27例(28.7%),未受侵67例(71.3%),其诊断敏感度、准确性、特异度、阳性预测值、阴性预测值分别86.6%、94.6%、98.4%、96.2%、94.0%;CEUS诊断SMV受侵26例(27.6%),未受侵68例(72.4%),其诊断敏感度、准确性、特异度、阳性预测值、阴性预测值分别为75.0%、87.2%、92.4%、80.7%、89.7%。结论 CEUS作为一种安全、无创、相对廉价的有效诊断方法,对胰腺恶性肿瘤的诊断及对胰周血管侵犯的评估有较高的临床应用价值,可对能否行外科手术切除作出术前评估,值得临床推广应用。

Objective To evaluate the clinical value of contrast-enhanced ultrasound(CEUS)in predicting peripancreatic vascular invasion in pancreatic carcinoma through comparison with the findings on surgical exploration.Methods A total of94pancreatic cancer patients(confirmed by pathological examination)were included in this study.The CEUS data were analyzed retrospectively.The enhancement characteristics of lesions were documented.And the peripancreatic vascular invasion were analyzed.The main features of peripancreatic vascular invasion on CEUS were as followings:1)peripancreatic arteries to be embedded,trapped in the tumor or surrounded by tumor,or to have intraluminal infiltration or luminal stenosis.2)superior mesenteric vein,portal vein to be surrounded by tumor or to be narrow,distorted or occluded.The CEUS findings were compared with postoperative pathological results.Results94patients were diagnosed with pancreatic cancer by pathological examination,including62cases of pancreatic head carcinoma,32cases of pancreatic tail carcinoma.The imaging of contrast-enhanced ultrasound showed6cases(6.4%)of high uneven enhancement,78cases(83%)of low uneven enhancement,and10cases(10.6%)of heterogeneous enhancement in parenchyma phase,respectively.Twenty-five cases(26.6%)of CA invasion were detected by CEUS,while no invasion was observed in69cases(73.4%).Compared with pathological findings,the predictive sensitivity,accuracy,specificity,positive predictive value,negative predictive value of CEUS were63.6%,79.7%,84.7%,56.0%,88.0%,respectively.Twenty-seven cases(28.7%)of SMA invasion were detected by CEUS,while no invasion were observed in67cases(71.3%).Compared with pathological findings,the predictive sensitivity,accuracy,specificity,positive predictive value,negative predictive value of CEUS were66.6%,77.6%,80.2%,44.0%,91.0%,respectively.Besides,PV invasion features were found in27cases(28.7%),while67(71.3%)cases were detected without invasion features.Compared with pathological findings,sensitivity,accuracy,specificity,positive predictive value,negative predictive value of CEUS in predicting PV invasion were86.6%,94.6%,98.4%,96.2%,94.0%,respectively.Furthermore,CEUS detected SMV invasion in26cases(27.6%),while no invasion features in68(72.4%)cases.The sensitivity,accuracy,specificity,positive predictive value,negative predictive value for CEUS were75.0%,87.2%,92.4%,80.7%,89.7%,respectively.Conclusion Due to its good diagnostic and predictive performance in detecting malignant pancreatic tumors and peripancreatic vascular invasion,CEUS could be served as an effective predictive modality in assessing the resectability of pancreatic carcinoma.