超声内镜与增强CT、MRI在胰腺疾病诊断中的价值评估

Evaluation of the diagnostic value in pancreatic diseases with the endoscopic ultrasonography, enhanced CT and MRI

目的评估不同检查方法对同一胰腺病变的诊断准确率及误差率。方法纳入2015年10月~2018年11月于我院诊治的胰腺病变患者70例,每例患者按照检查的先后顺序予以腹部增强CT、MRI、超声内镜(EUS)或EUS引导下的细针穿刺术(EUS-FNA)检查。以患者手术后的病理检查结果或治疗随访至少3 ~6个月的临床结局作为诊断金标准,评估诊断的准确率、阳性诊断率及误差率。结果 EUS/EUS-FNA诊断准确率为91.4%,较增强CT(68.6%)及MRI(84.3%)更高。不同检查方式诊断不同胰腺疾病的误差率差异较大。其中EUS/EUS-FNA在诊断囊性病变的胰腺癌、神经内分泌肿瘤、胰岛素瘤和胰腺结核等方面优于或略优于增强CT及MRI,而增强CT及MRI检查在自身免疫性胰腺炎诊断方面的优势更为明显。结论不同的检查方法对不同胰腺疾病诊断的准确率存在差异,且各有优缺点。

Objective To evaluate the diagnostic accuracy and misdiagnosis rate for the same pancreatic lesions by different methods. Methods Seventy cases of pancreatic lesions patients from October 2015 to November 2018 in our hospital were included. The enhanced computed tomography ( CT)/ Magnetic Resonance Imaging ( MRI )/Endoscopic Ultrosonogragpy ( EUS )/EUS-Fine-needle aspiration (EUS-FNA) examinations were given to every patient according to the order of examination. The pathological results after surgery and the following up clinical results were regarded as the golden standard to evaluate the diagnosis accuracy, possible diagnosis rate and misdiagnosis rate. Results The diagnostic accuracy of EUS/EUS-FNA(91.4%) was higher than enhanced CT (68. 6%) and MRI ( 84. 3%). The misdiagnosis rates by different methods were quite different. EUS/EUS-FNA was superior to enhanced CT and MRI in the diagnosis of cystic pancreatic cancers, neuroendocrine tumors, insulinoma and pancreatic tuberculosis. However, for the autoimmunity pancreatitis, enhanced CT and MRI was better than EUS. Conclusion Different methods have different accuracy diagnostic rate for the different pancreatic diseases with different advantages and disadvantages.