谐波造影增强超声内镜在胰腺囊性病变中的诊断价值

Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography for pancreatic cystic lesions

目的评价谐波造影增强超声内镜(CEH-EUS)在胰腺囊性病变中的诊断价值。方法回顾性分析2013年3月至2020年4月间海军军医大学第一附属医院消化内科经EUS诊断为胰腺囊性病变且有CEH-EUS录像患者的内镜和临床随访资料。结果共纳入36例患者,其中浆液性囊性肿瘤(SCA)16例、黏液性囊性肿瘤(MCN)10例、导管内乳头状黏液性肿瘤(IPMN)5例(3例混合型、2例主胰管型)、胰腺假性囊肿(PPC)5例。87.5%(14/16)SCA和86.7%(13/15)MCN+IPMN的囊壁呈造影高增强效应,达峰明显,消退与周围组织同步,而只有20%(1/5)PPC的囊壁呈高增强效应,PPC的高增强效应显著低于SCA、MCN+IPMN,差异均有统计学意义(P值分别为0.0035、0.0048)。共17例EUS检出胰腺囊性病变内存在壁结节,其中3例CEH-EUS检查显示为高增强回声,其余14例均显示为低增强回声。高增强回声的3例最终都诊断为恶性胰腺囊性肿瘤(1例IPMN,2例MCN),诊断准确率达100%。结论CEH-EUS在区分PPC和其他胰腺囊性病变上具有明显优势,而区分MCN和SCA意义不大。胰腺囊性病变内壁结节在CEH-EUS模式下显示为高增强预示着恶变潜能。

Objective To evaluate diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography(CEH-EUS)for pancreatic cystic lesions.Methods Endoscopic and clinical follow-up data of patients with pancreatic cystic lesions diagnosed by EUS in Department of Gastroenterology of the First Affiliated Hospital of Naval Medical University with CEH-EUS video from March 2013 to April 2020 was retrospectively analyzed.Results A total of 36 patients were included.There were 16 cases of serous cystadenomas(SCA),10 cases of mucinous cystic neoplasm(MCN),5 cases of intraductal papillary mucinous neoplasms(IPMN,3 with complex type,2 with main pancreatic duct type)and 5 cases of pancreatic pseudocyst(PPC).87.5%(14/16)of SCA and 86.7%(13/15)of MCN+IPMN had hyperenhanced cystic wall with obvious peak and similar washout as surrounding tissue,whereas only 20%(1/5)PPC had hyperenhanced cystic wall.The hyperenhancing effect of PPC was significantly lower than that of SCA and MCN+IPMN(P=0.0035 and P=0.0048,respectively).Mural nodules were detected in 17 cases of pancreatic cystic lesions by EUS,of which 3 cases had hyperenhanced mural modules and 14 cases had hypoenhanced mural nodules by CEH-EUS.Patients showing hyperenhanced mural modules were all finally diagnosed as pancreatic malignancy(1 IPMN,2 MCN),and the accuracy was 100%.Conclusions CEH-EUS can have a obvious advantage of differentiating pseudocyst and other pancreatic cystic lesions,while not very useful for differentiating SCA and MCN.Pancreatic cystic lesions showing hyperenhanced mural nodules under CEH-EUS may imply malignancy potential.