造影增强EUS与胰腺疾病诊治.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;177:713-717Bhutani 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,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,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,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,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,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,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,