超声内镜、MRI在壶腹周围癌术前诊断中的应用价值

The Application Value of Endoscopic Ultrasonography and MRI in Preoperative Diagnosis of Periampullary Carcinoma

目的探讨超声内镜(EUS)、核磁共振(MRI)在壶腹周围癌(PAC)术前诊断中的应用价值。方法选取2020年9月~2022年8月我院收治的130例疑似PAC患者,回顾性分析其临床资料,术前均行EUS、MRI检查,以病理结果为金标准,比较两种检查方法对PAC的检出率。结果①病理结果显示,130例疑似PAC患者,确诊胰头癌56例,壶腹癌18例,胆总管癌14例,十二指肠癌5例,胆总管结石37例。②EUS对胰头癌、壶腹癌、胆总管癌、十二指肠癌的检出率高于MRI,差异有统计学意义(P<0.05)。③以病理结果为金标准,EUS诊断PAC的准确度为96.2%,敏感度为96.8%,特异度为94.6%,阴性预测值为92.1%,阳性预测值为97.8%,假阳性率为5.4%,假阴性率为3.2%,正确指数为0.91;MRI诊断PAC的准确度为75.4%,敏感度为72.0%,特异度为83.8%,阴性预测值为54.4%,阳性预测值为91.8%,假阳性率为16.2%,假阴性率为28.0%,正确指数为0.56。④kappa一致性分析显示,EUS检查结果与病理结果的一致性Kappa值为0.906,两者一致性处于较高水平;MRI检查结果与病理结果的一致性Kappa值为0.480,两者一致性处于中等水平。结论与MRI相比,EUS是诊断PAC最灵敏、准确的检查方法,可清晰显示壶腹周围结构及病变部位,有利于提高PAC术前诊断准确性,为临床术式选择提供帮助。

Objective To explore the application value of endoscopic ultrasonography(EUS)and magnetic resonance imaging(MRI)in preoperative diagnosis of periampullary carcinoma(PAC).Methods A total 130 suspected PAC patients admitted to our hospital from September 2020 to August 2022 were selected,and their clinical data were analyzed retrospectively.All patients were examined by EUS and MRI before operation.The detection rates of PAC by the two methods were compared based on the pathological results.Results①The pathological results showed that 56 patients were diagnosed as pancreatic head carcinoma,18 patients were diagnosed as ampullary carcinoma,14 patients were diagnosed as common bile duct cancer,5 patients were diagnosed as duodenal carcinoma and 37 patients were diagnosed as choledocholithiasis.②The detection rates of EUS for pancreatic head carcinoma,ampullary carcinoma,common bile duct cancer,and duodenal carcinoma were higher than those of MRI,and their differences were statistically significant(P<0.05).③Taking the pathological results as the gold standard,the accuracy,susceptibility,specificity,negative predictive value,positive predictive value,false positive rate,false negative rate and correct index of EUS in diagnosing PAC were 96.2%,96.8%,94.6%,92.1%,97.8%,5.4%,3.2% and 0.91 respectively,and the accuracy,susceptibility,specificity,negative predictive value,positive predictive value,false positive rate,false negative rate and correct index of MRI in diagnosing PAC were 75.4%,72.0%,83.8%,54.4%,91.8%,16.2%,28.0% and 0.56 respectively.④Kappa consistency analysis showed that the Kappa value of consistency between EUS examination results and pathological results was 0.906,and the consistency between the two was at a high level,the Kappa value of consistency between the MRI results and the pathological results was 0.480,and the consistency between the two was at a medium level.Conclusion Compared with MRI,EUS is the most sensitive and accurate examination method for the diagnosis of PAC.It can clearly display the structure around ampulla and the lesion sites,which is conducive to improving the accuracy of preoperative diagnosis of PAC and providing help for the selection of clinical operation.