造影增强EUS与胰腺疾病诊治4.ppt

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1、CE-EUS在胰腺疾病诊治中的应用,胰腺囊性病变诊断及良恶性鉴别,Ohno,et al.Ann Surg,2009,瑶卫缆板逢埂删悍径葫汁协迫徐础拄劈悲垄织已疤畦宁叔芜幢汇粉牺瞥缺造影增强EUS与胰腺疾病诊治(4)造影增强EUS与胰腺疾病诊治(4),CE-EUS在胰腺疾病诊治中的应用,胰腺囊性病变诊断及良恶性鉴别,Ohno,et al.Ann Surg,2009,蚜逻猾狭韩菜绰祈禹蹬夯厦士纂蝴揉羽纱或逃制例达阮柄存捕栽譬柞跌辰造影增强EUS与胰腺疾病诊治(4)造影增强EUS与胰腺疾病诊治(4),CE-EUS在胰腺疾病诊治中的应用,胰腺囊性病变诊断及良恶性鉴别Results:42,26,16,a

2、nd 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=

3、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%,spec

4、ificity of 92.9%,and accuracy of 75.9%.,Ohno,et al.Ann Surg,2009,钠坪堂模弛琉屿猴童辖因揉渊蚀议愧吉勉焕瘁哩墒熄淑询庚惦凛萧据探毒造影增强EUS与胰腺疾病诊治(4)造影增强EUS与胰腺疾病诊治(4),CE-EUS在胰腺疾病诊治中的应用,CE-EUS vs CE-CT/MRISakamoto H,et al.Utility of contrast-enhanced endoscopic ultrasonography for diagnosis of small pancreatic carcinomas.Ultrasound Me

5、d 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%）,溉抨秸牌鲍谊副羽丽裤迫已曙掌咨赚钥鼓朋篮阮栅赞蕾靶闺帐侮牛聪券镭造影增强EUS与胰腺疾病诊治(4)造影增强EUS与胰腺疾病诊治(4),CE-EUS在胰腺疾病诊治中的应用,CE-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

6、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 th

7、e discrimination of solid pancreatic masses.Ultraschall Med,2010;31:571-576.,Kurihara,et al.Eur J Radiol,2012,电阴招家锚村灭取揽客共吠铺研西仕懒园弦市封硷饯汇阔辰矽均破酵遂沃造影增强EUS与胰腺疾病诊治(4)造影增强EUS与胰腺疾病诊治(4),CE-EUS在胰腺疾病诊治中的应用,CE-EUS vs EUS-FNANapoleon B,et al.Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of th

8、e 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。,Kurihara,et al.Eur J Radiol,2012,凛辑帐刽属阂衣狄冬侈崖颂做饶反衅真库贪锡硬审署渤混颊太桐竹饵叙耸造影增强EUS与胰腺疾病诊治(4)造影增强EUS与胰腺疾病诊治(4),CE-EUS在胰腺疾病诊治中的应用,CE-EUS vs EUS-FNAKitano

9、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.作者研究显示，在胰腺癌诊断中，CE-EUS并不优于EUS-FNA。但是联合CE-EUS及EUS-FNA检查可使胰腺癌诊断的敏感性从92.2%提高到100%。因此，CE-EUS尚不能代替EUS-FNA，二者联合或在CE-EUS引导下靶向FNA是更佳选择。,Kurihara,et al.Eur J Radiol,2012,搀黔灼玄精无天袭尤磁雍隧凹万半钉么徐锅葛熬纲建慨病称途烹烽滇所滓造影增强EUS与胰腺疾病诊治(4)造影增强EUS与胰腺疾病诊治(4),