造影增强EUS与胰腺疾病诊治1.ppt

造影增强内镜超声在胰腺疾病诊治中的作用 孙金山 造影增强超声的发展 静脉造影剂最早用于心血管疾病超声检查，以增强心腔及大血管的超声显像 Keller MW, Feinstein SB, Watson DD. Successful left ventricular opacification following peripheral venous injection of sonicated contrast agent: an experimental evaluation. Am Heart J 1987; 114: 570-575 此后，该项技术在经腹超声及内镜超声领域快速发展 Goldberg BB, Hilpert PL, Burns PN, Liu JB, Newman LM, Merton DA, Witlin LA. Hepatic tumors: signal enhancement at Doppler US after intravenous injection of a contrast agent. Radiology 1990; 177: 713-717 Bhutani MS, Hoffman BJ, van Velse A, Hawes RH. Contrast-enhanced endoscopic ultrasonography with galactose microparticles: SHU508 A (Levovist). Endoscopy 1997;29:635-639 静脉造影剂的类型及组成 胰腺疾病常规EUS的优势与不足 优势 更接近病变，能够更好地显示病变的组织结构及病变与周围脏器和血管的关系 经EUS-FNA获取细胞/组织/囊液 对病变的诊断、肿瘤分级/分期、术前定位等可能优于CT/MRI 不足 对肿瘤血管等显示欠佳 对一些形态相近病变，如肿块型胰腺炎vs胰腺癌vs胰腺神经内分泌肿瘤、多种胰腺囊性病变等，诊断及良恶性鉴别存在困难 CE-EUS在胰腺疾病诊治中的应用 ㈠肿块型胰腺炎与胰腺癌（PDAC）的鉴别 D Becker,et al. Gastrointest Endosc,2001 CE-EUS在胰腺疾病诊治中的应用 ㈠肿块型胰腺炎与胰腺癌（PDAC）的鉴别 D Becker,et al. Gastrointest Endosc,2001 CE-EUS在胰腺疾病诊治中的应用 ㈠肿块型胰腺炎与胰腺癌（PDAC）的鉴别 Gheonea et al. BMC Gastroenterology，2013 CE-EUS在胰腺疾病诊治中的应用 ㈠肿块型胰腺炎与胰腺癌（PDAC）的鉴别 Gheonea et al. BMC Gastroenterology，2013 CE-EUS在胰腺疾病诊治中的应用 ㈠肿块型胰腺炎与胰腺癌（PDAC）的鉴别 Gheonea et al. BMC Gastroenterology，2013 CE-EUS在胰腺疾病诊治中的应用 ㈠肿块型胰腺炎与胰腺癌的鉴别 Results：sensitivity and specificity of low MI contrast enhanced EUS using TIC analysis were 93.75% (95% CI = 77.77-98.91%) and 89.47% (95% CI = 65.46-98.15%), respectively. The positive predictive value of TIC analysis was 93.75% (95% CI = 77.78-98.91%) and the negative predictive value was 89.47% (95% CI = 65.46-98.15%). Gheonea et al. BMC Gastroenterology，2013 * * Figure 1. EUS image showing hypoechoic mass (arrow) in the uncinate process (dashed line); scanning is from duodenum; no perfusion signals visible. Figure 2. EUS image in same patient as Figure 1 after injection of FS069 (Optison). There is a marked increase in signal intensity in the surrounding tissue, but still no power-Doppler signals