| 桂阳,陈雪琪,吕珂,谭莉,张璟,孝梦甦,陈天娇,李京璘,贾琬莹,李建初,姜玉新.超声造影预测≤3 cm胰腺导管腺癌[J].中国医学影像技术,2021,37(12):1779~1783 |
| 超声造影预测≤3 cm胰腺导管腺癌 |
| Contrast enhanced ultrasound for prediction of pancreatic ductal adenocarcinoma (less than 3 cm) |
| 投稿时间：2021-09-24 修订日期：2021-11-19 |
| DOI：10.13929/j.issn.1003-3289.2021.12.005 |
| 中文关键词: 胰腺肿瘤 超声检查 |
| 英文关键词:pancreas neoplasms ultrasonography |
| 基金项目:国家自然科学基金（81873902）、中国医学科学院医学与健康科技创新工程（2020-I2M-C&T-B-039）。 |
| 作者 | 单位 | E-mail | | 桂阳 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 陈雪琪 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 吕珂 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | lvke@163.com | | 谭莉 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 张璟 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 孝梦甦 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 陈天娇 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 李京璘 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 贾琬莹 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 李建初 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | | | 姜玉新 | 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730 | |
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| 中文摘要: |
| 目的 评价超声造影（CEUS）预测胰腺导管腺癌（PDAC）的价值。方法 纳入75例胰腺局灶实性病变（最大径≤ 3 cm）患者，观察病灶常规超声及CEUS表现，并根据最终诊断结果分为PDAC组（n=47）及非PDAC组（n=28），比较组间超声表现差异；绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），评价CEUS预测PDAC的效能。结果 75例胰腺局灶实性病灶均表现为低回声，最大径0.9~3.0 cm，中位数2.40（2.10，2.80）cm；其中26.67%（20/75）边界清晰，73.33%（55/75）边界模糊。CEUS中，动脉期57.33%（43/75）病灶呈低增强，33.33%（25/75）呈等增强，9.33%（7/75）呈高增强，其中81.33%（61/75）呈均匀增强；静脉期81.33%（61/75）病灶呈低增强，8.00%（6/75）呈等增强，10.67%（8/75）呈高增强；6.67%（5/75）病灶表现为极快速廓清，58.67%（44/75）表现为快速廓清，32.00%（24/75）表现为缓慢廓清，2.67%（2/75）表现为同步廓清。PDAC组病灶边界多模糊（43/47，91.49%），动脉期（31/47，65.96%）及静脉期（47/47，100%）多呈低增强，且多呈极快或快速廓清（43/47，91.49%）；非PDAC组病灶边界多清晰（16/28，57.14%），动脉期（16/28，57.14%）多呈等或高增强，静脉期呈低增强及等/高增强各半，廓清模式多为缓慢或同步廓清（22/28，78.57%）；组间病灶边界清晰度、静脉期增强程度及廓清模式差异均有统计学意义（P均<0.05），动脉期增强程度差异无统计学意义（P=0.05）。以静脉期低增强及造影剂极快/快速廓清预测PDAC的AUC分别为0.750及0.850，敏感度分别为100%及91.49%，特异度分别为50.00%及78.57%。结论 CEUS可实时评价胰腺局灶实性病变微血流灌注；根据造影剂极快速/快速廓清诊断最大径≤ 3 cm PDAC优于静脉期低增强表现。 |
| 英文摘要: |
| Objective To observe the value of contrast enhanced ultrasound (CEUS) for predicting pancreatic ductal adenocarcinoma (PDAC). Methods A total of 75 patients with the maximum diameter less than 3 cm focal pancreatic solid lesion were enrolled, and conventional ultrasound and CEUS findings of the lesions were observed. The patients were then divided into PDAC group (n=47) and non-PDAC group (n=28) according to the final diagnostic results, and the ultrasonic performances were compared between groups. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the efficiency of CEUS for predicting PDAC. Results Ultrasound showed all pancreas focal solid lesions were hypoechoic, with the maximum diameter of 0.9-3.0 cm and the median of 2.40 (2.10, 2.80) cm. Totally 26.67% (20/75) lesions had well-defined borders, while the other 73.33% (55/75) had fuzzy borders. During the arterial phase of CEUS, 57.33% (43/75) lesions showed hypo-enhancement, 33.33% (25/75) showed iso-enhancement and 9.33% (7/75) showed hyper-enhancement, and uniform enhancement was observed in 81.33% (61/75) lesions. During the venous phase of CEUS, hypo-enhancement was observed in 81.33% (61/75)lesions, while iso-enhancement was found in 8.00% (6/75) and hyper-enhancement in 10.67% (8/75) lesions. Extremely rapid washout was detected in 6.67% (5/75) lesions, while rapid washout, slow washout and synchronous washout was noticed in 58.67% (44/75), 32.00% (24/75) and 2.67% (2/75) lesions, respectively. In PDAC group, fuzzy borders (43/47, 91.49%), hypo-enhancement during arterial phase (31/47, 65.96%) and venous phase (47/47, 100%), as well as extremely rapid/rapid washout (43/47, 91.49%) were found in most lesions. In non-PDAC group, well-defined borders(16/28, 57.14%) and iso/hyper-enhancement (16/28, 57.14%) during the arterial phase were observed in more than half of the lesions, half with hypo-enhancement and half with iso/hyper-enhancement during the venous phase, 78.57%(22/28) with slow or synchronous washout. The lesion margins, venous phase enhancement degrees and washout patterns were all different (all P<0.05), but there was no statistically difference of arterial phase enhancement degrees (P=0.05) between groups. The AUC of venous phase hypo-enhancement and extremely rapid/rapid washout for predicting PDAC was 0.750 and 0.850, the sensitivity was 100% and 91.49%, and the specificity was 50.00% and 78.57%, respectively. Conclusion CEUS could demonstrate real-time micro-perfusion of focal pancreatic solid lesions. Contrast media rapid/rapid washout had better effect than venous phase hypo-enhancement for predicting PDAC with the maximum diameter ≤ 3 cm. |
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