造影增强EUS与胰腺疾病诊治4.ppt

CE-EUS在胰腺疾病诊治中的应用 ㈢胰腺囊性病变诊断及良恶性鉴别 Ohno,et al. Ann Surg,2009 CE-EUS在胰腺疾病诊治中的应用 ㈢胰腺囊性病变诊断及良恶性鉴别 Ohno,et al. Ann Surg,2009 CE-EUS在胰腺疾病诊治中的应用 ㈢胰腺囊性病变诊断及良恶性鉴别 Results: 42, 26, 16, and 3 were pathologically diagnosed as adenoma, noninvasive carcinoma, invasive IPMNs, and coexistent invasive ductal cancer, respectively. Multivariable logistic regression analysis showed that types III/IV mural nodule (odds ratio=10.8; 95% confidential intervals=2.75-56.1) and symptomatic IPMNs (odds ratio=4.31; 95% confidential intervals =1.37-14.7) were significant for malignancy. Types III （88.9%） and IV （91.7%）mural nodules were more frequently associated with malignancy, particularly invasive cancer. The diagnosis of IPMNs with types III or IV mural nodule as malignant resulted in a sensitivity of 60%, specificity of 92.9%, and accuracy of 75.9%. Ohno,et al. Ann Surg,2009 CE-EUS在胰腺疾病诊治中的应用 ㈢CE-EUS vs CE-CT/MRI Sakamoto H, et al. Utility of contrast-enhanced endoscopic ultrasonography for diagnosis of small pancreatic carcinomas. Ultrasound Med Biol. 2008;34(4):525-532. 在纳入研究的156例患者中有36例最终证实为≤2cm的胰腺癌，作者比较了CE-EUS与CE-CT发现和鉴别胰腺癌的能力，结果表明前者敏感性更高（94.4% vs 50%） CE-EUS在胰腺疾病诊治中的应用 ㈢CE-EUS vs EUS 由于病变与周围胰腺实质的血供存在差异，CE-EUS使胰腺癌、肿块型胰腺炎、胰腺神经内分泌肿瘤等显示更清晰，对此类病变的诊断和鉴别诊断更加准确；定量谐波CE-EUS进一步提高其准确率和客观性。 Kitano M, Kudo M, Yamao K.et al. Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol, 2012;107:303-310. Seicean A, Badea R, Stan-Iuga R, et al. Quantitative contrast-enhanced harmonic endoscopic ultrasonography for the discrimination of solid pancreatic masses. Ultraschall Med, 2010 ;31:571-576. Kurihara,et al. Eur J Radiol,2012 CE-EUS在胰腺疾病诊治中的应用 ㈢CE-EUS vs EUS-FNA Napoleon B, et al. Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: results of a pilot study. Endoscopy, 2010;42(7):564-570. 作者比较35例患者行CE-EUS及EUS-FNA诊断的情况，结果显示CE-EUS敏感性优于EUS-FNA；4例EUS-FNA假阴性的病例，CE-EUS图像上病变为低增强，诊断为胰腺癌。 Kurihar