Dynamic Quantitative Evaluation of Contrast-Enhanced Endoscopic Ultrasonography in the Diagnosis of Pancreatic Diseases

作者：Matsubara Hiroshi; Itoh Akihiro; Kawashima Hiroki; Kasugai Toshifumi; Ohno Eizaburo; Ishikawa Takuya; Itoh Yuya; Nakamura Yosuke; Hiramatsu Takeshi; Nakamura Masanao; Miyahara Ryoji; Ohmiya Naoki; Ishigami Masatoshi; Katano Yoshiaki; Goto Hidemi; Hirooka Yoshiki^*

来源：Pancreas, 2011, 40(7): 1073-1079.

DOI：10.1097/MPA.0b013e31821f57b7

• contrast-enhanced endoscopic ultrasonography
• time-intensity curve
• dynamic quantitative analysis
• second-generation ultrasound contrast agent
• pancreatic ductal cancer
• inflammatory pancreatic pseudotumor

Objectives: This study aimed to investigate the usefulness of contrast-enhanced endoscopic ultrasonography (EUS) with time-intensity curve (TIC) in differentiating pancreatic diseases.
Methods: Patients who underwent contrast-enhanced EUS between January 2007 and June 2009 were analyzed retrospectively, including 48 with pancreatic ductal cancer (PC), 14 with autoimmune pancreatitis (AIP), 13 with mass-forming pancreatitis (MFP), and 16 with pancreatic endocrine tumor (PET). After intravenous injection of contrast agent, contrast imaging pattern, TIC-based quantitative evaluation, and diagnostic ability of EUS in combination with TIC to diagnose benignancy or malignancy were assessed.
Results: Hypovascular and heterogeneous pattern (42/48) in PC, isovascular and homogenous (21/27) in AIP and MFP, and hypervascular and rapid stained (16/16) in PET were observed. The echo intensity reduction rate from the peak at 1 minute was the greatest in PC followed by MFP, AIP, and PET (P < 0.05). The diagnostic accuracies based on contrast imaging pattern (84.0%) and TIC (88.0%) were higher than those based on B-mode imaging (82.6%) and dynamic computed tomography (81.3%). In EUS in combination with TIC, sensitivity, specificity, and accuracy rose up to 95.8%, 92.6%, and 94.7%, respectively.
Conclusions: Contrast-enhanced EUS with the dynamic quantitative analysis preparing TIC increased the diagnostic accuracy for pancreatic diseases.

• 出版日期2011-10