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1、CE-EUS在胰腺疾病诊治中的应用在胰腺疾病诊治中的应用u胰腺囊性病变诊断及良恶性鉴别胰腺囊性病变诊断及良恶性鉴别Ohno,et al. Ann Surg,2009CE-EUS在胰腺疾病诊治中的应用在胰腺疾病诊治中的应用u胰腺囊性病变诊断及良恶性鉴别胰腺囊性病变诊断及良恶性鉴别Ohno,et al. Ann Surg,2009CE-EUS在胰腺疾病诊治中的应用在胰腺疾病诊治中的应用u胰腺囊性病变诊断及良恶性鉴别胰腺囊性病变诊断及良恶性鉴别lResults: 42, 26, 16, and 3 were pathologically diagnosed as adenoma, noninvasi
2、ve carcinoma, invasive IPMNs, and coexistent invasive ductal cancer, respectively. lMultivariable 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)
3、were significant for malignancy. Types III （88.9%） and IV （91.7%）mural nodules were more frequently associated with malignancy, particularly invasive cancer. lThe 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
4、 75.9%.Ohno,et al. Ann Surg,2009CE-EUS在胰腺疾病诊治中的应用在胰腺疾病诊治中的应用uCE-EUS vs CE-CT/MRIlSakamoto H, et al. Utility of contrast-enhanced endoscopic ultrasonography for diagnosis of small pancreatic carcinomas. Ultrasound Med Biol. 2008;34(4):525-532.l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
5、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在胰腺疾病诊治中的应用uCE-EUS vs EUSl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。lKitano M, Kudo M, Yamao K.et al. Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endos
6、copic ultrasonography. Am J Gastroenterol, 2012;107:303-310.lSeicean 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,2012CE-EUS在胰腺疾病诊治中
7、的应用在胰腺疾病诊治中的应用uCE-EUS vs EUS-FNAlNapoleon 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.l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.
8、Eur J Radiol,2012CE-EUS在胰腺疾病诊治中的应用在胰腺疾病诊治中的应用uCE-EUS vs EUS-FNAlKitano 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.l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%。l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
