胃肠胰神经内分泌肿瘤肝转移超声表现及穿刺活检价值

Sonographic characteristics and value of ultrasound⁃guided needle biopsy of gastrointestinal pancreatic neuroendocrine tumors with liver metastases

目的探讨胃肠胰神经内分泌肿瘤肝转移的常规超声声像图特点、超声造影表现及穿刺活检的应用价值。方法回顾性分析解放军总医院第五医学中心53例胃肠胰神经内分泌肿瘤肝转移患者的超声表现及穿刺活检结果,其中6例行超声造影。结果53例中,原发灶胰腺来源42例,胃肠来源11例。原发灶与肝转移同时诊断39例(73.6%)。胃肠胰神经内分泌肿瘤肝转移超声表现主要为多发、不均的高或低回声实性占位,与病灶最大径>3 cm组相比,≤3 cm组肝转移灶在血流信号检出率上显著不同,两组在病灶的形态、边界、回声、均匀性方面均无明显差异。超声造影特点多为动脉期整体高增强,门脉期及延迟期低增强。超声引导下1次穿刺活检成功率100%,无严重并发症,均可提供明确病理诊断及组织学分级。结论不同大小的胃肠胰神经内分泌肿瘤的肝转移灶超声声像图表现差异不大,较大的肿瘤更易检测出血流信号,而超声引导下穿刺活检简单、安全、准确、微创。

Objective To investigate the features of conventional ultrasonography,manifestations of contrast⁃enhanced ultrasound and the applicability of ultrasound⁃guided needle biopsy(USGB)in liver metastases of gastrointestinal pancreatic neuroendocrine tumors(GEP⁃NENs).Methods Fifty⁃three patients with liver metastases of GEP⁃NENs were examined by color doppler sonography and USGB,six of whom underwent contrast⁃enhanced ultrasound examination,before the results were analyzed retrospectively.Results Among the 53 cases,42 cases were from pancreas and the rest were from the gastrointestinal system.Primary foci and liver metastasis were simultaneously detected in 39 cases(73.6%).The ultrasonic manifestations of liver metastasis of GEP⁃NENs were mostly multiple and uneven solid masses with high or low echo.The detection rate of blood flow signals of liver metastasis in the≤3 cm group was significantly different from that of the>3 cm group,and there were no significant differences in morphology,boundaries,echo and uniformity between the two groups.In contrast ultrasonography,the two groups showed high overall enhancement in the arterial phase and low enhancement in the portal vein phase and delay phase.The success rate of ultrasound⁃guided needle puncture was 100%,without serious complications,which can provide clear pathological diagnosis and histological grading.Conclusion The ultrasonographic findings of liver metastases in different sizes of GEP⁃NENs are not different,and blood flow signals are more easily detected in larger tumors.Ultrasound⁃guided puncture biopsy is simple,safe,accurate and minimally invasive.