超声造影定性及定量分析在胰腺导管腺癌与非导管腺癌鉴别诊断中的应用价值

Application of qualitative and quantitative analysis of contrast-enhanced ultrasound in the differential diagnosis of pancreatic ductal adenocarcinoma and non-pancreatic ductal adenocarcinoma

目的探讨超声造影(CEUS)定性特征及定量参数在以胰腺实性局灶性病变为表现的导管腺癌(PDAC)与非导管腺癌(non-PDAC)鉴别诊断中的应用价值。方法回顾性分析2022年7月至2023年6月于天津医科大学肿瘤医院接受CEUS检查的PDAC患者64例和non-PDAC患者52例,比较两组间临床特征、二维超声特征、CEUS定性特征及定量参数的差异,构建ROC曲线并采用Delong检验评价定性及定量分析鉴别PDAC和non-PDAC的效能,采用二元Logistic回归分析评估PDAC的独立预测因素。结果①两组血清糖类抗原19-9(CA19-9)、病变长径、边界、主胰管(MPD)内径、增强程度及增强模式等差异有统计学意义(均P<0.05)。②PDAC组相对峰值强度(rPE)、相对灌注-廓清曲线下面积(rWiWoAUC)低于non-PDAC组,差异有统计学意义(均P<0.05)。③增强模式、静脉期增强程度、rPE、rWiWoAUC诊断PDAC的曲线下面积(AUC)分别为0.698、0.707、0.863、0.867,定量参数的AUC优于定性特征,差异有统计学意义(P<0.05)。以CEUS模式B、静脉期低增强、rPE<72.44、rWiWoAUC<86.59为截断值,诊断PDAC的准确性分别为0.698、0.741、0.828、0.802。④患者血清CA19-9、病变长径、MPD内径、rPE及rWiWoAUC是PDAC的独立预测因素(均P<0.05)。结论CEUS定性及定量分析有助于PDAC与non-PDAC的鉴别诊断,rPE、rWiWoAUC是诊断PDAC的有用指标。

Objective To explore the application value of qualitative characteristics and quantitative parameters of contrast-enhanced ultrasound(CEUS)in the differential diagnosis of pancreatic ductal adenocarcinoma(PDAC)and non-PDAC presenting as pancreatic solid focal lesions.MethodsA retrospective analysis was conducted on 64 cases of PDAC(the PDAC group)and 52 cases of non-PDAC(the non-PDAC group)who underwent CEUS examination at Tianjin Medical University Cancer Institute and Hospital from July 2022 to June 2023.Clinical characteristics,two-dimensional ultrasound features,CEUS qualitative characteristic,and quantitative parameters were compared between the two groups.ROC curves were plotted,and the Delong test was used to evaluate the diagnostic performance of qualitative and quantitative analyses in distinguishing PDAC from non-PDAC.Binary logistic regression analysis was employed to assess the independent predictors of PDAC.Results①There were significant differences in serum CA19-9,lesion size,boundary,the main pancreatic duct(MPD)diameter,degree of enhancement and enhancement pattern between the PDAC group and the non-PDAC group(all P<0.05).②The relative peak intensity(rPE),and relative wash-in and wash-out area under the curve(rWiWoAUC)were lower in the PDAC group than the non-PDAC group,with statistically significant differences(all P<0.001).③The areas under the curve(AUC)for diagnosing PDAC using enhancement pattern,venous phase(VP)enhancement degree,rPE,and rWiWoAUC were 0.698,0.707,0.863,and 0.867,respectively.The AUCs of quantitative parameters were superior to those of qualitative characteristics,with statistically significant differences(P<0.05).Using CEUS mode B,low VP enhancement,rPE<72.44,and rWiWoAUC<86.59 as cut-off values,the accuracies for diagnosing PDAC were 0.698,0.741,0.828,and 0.802,respectively.④Serum CA19-9,lesion size,MPD diameter,rPE,and rWiWoAUC were independent predictors of PDAC(all P<0.05).ConclusionsCEUS qualitative and quantitative analyses are helpful in the differential diagnosis of PDAC and non-PDAC,with rPE and rWiWoAUC being useful indicators for diagnosing PDAC.