-IDUS对胆胰管疾病的应用体会.pptVIP

Advances of IDUS in Diagnosis for Billiary Diseases Xiaoping Zou Department of Gastroenterology Nanjing Drum Tower Hospital Nanjing University School of Medicine Nanjing, China Intra-ductal Ultrasonography, IDUS Advantages of IDUS With a finer probe, can get approach to the target site through working channel of the endoscopy Get clearer images without the interference of air and fat Probe with higher frequency is enabled with a close distance Images of high resolution IDUS vs. routine EUS The tubular structure of pancreato-billiary duct facilitate the acoustical coupling Fluid in duct can be used as medium of ultrasound The diameter of the duct is slightly larger than thant of the probe Higher frequency (12-30MHz) Better image resolution Type of probe Electronic circular scan Synchronized double section scan Mechanical radial scan Images of normal billiary duct 2-3 layers Thickness: 0.31-0.79mm Smooth layer with homogenous echo First layer: hyper-echogenicity, represents the interphase Second layer: hypo-echogenicity, represents mucosal and muscularis propria layers Outer layer: hyper-echogenicity, the echo of fat and interface between serosa and other organs Clinical application Billiary duct Suspected stone in billiary duct Differentiation for stenosis Tumor staging Pancreatic duct Differentiation for stenosis Tumor staging Showing details of cystic neoplasms Localization of neuro-endocrine tumors not detcted by EUS Suspected stone in CBD CBD stones N=35 （with suspected stones） Of 21 patients with stones not detected by ERCP, IDUS identified 8, in which 7 were proved by EST Of 5 patients with suspected stones under ERCP, IDUS identified them as bubbles IDUS changed the clinical strategies in 13 (37%) patients Catanzaro, A, Pfau, P, Isenberg, GA, Wong, RC. Clinical utility of intraductal US for evaluation of choledocholithiasis. Gastrointest Endosc 2003; 57:648. N=62 Detect rate of cholangiography : 87%