造影增強EUS與胰腺疾病診治(1)ppt課件

1、孫金山孫金山造影加強超聲的開展造影加強超聲的開展u 靜脈造影劑最早用于心血管疾病超聲檢查，以加強心腔靜脈造影劑最早用于心血管疾病超聲檢查，以加強心腔及大血管的超聲顯像及大血管的超聲顯像u Keller MW, Feinstein SB, Watson DD. Successful Keller MW, Feinstein SB, Watson DD. Successful left ventricular opacification following left ventricular opacification following peripheral venous injection of

2、 sonicated contrast peripheral venous injection of sonicated contrast agent: an experimental evaluation. Am Heart J agent: an experimental evaluation. Am Heart J 1987; 114: 570-5751987; 114: 570-575u 以后，該項技術(shù)在經(jīng)腹超聲及內(nèi)鏡超聲領(lǐng)域快速開展以后，該項技術(shù)在經(jīng)腹超聲及內(nèi)鏡超聲領(lǐng)域快速開展u Goldberg BB, Hilpert PL, Burns PN, Liu JB, Newman Go

3、ldberg BB, Hilpert PL, Burns PN, Liu JB, Newman LM, Merton DA, Witlin LA. Hepatic tumors: signal LM, Merton DA, Witlin LA. Hepatic tumors: signal enhancement at Doppler US after intravenous enhancement at Doppler US after intravenous injection of a contrast agent. Radiology 1990; injection of a cont

4、rast agent. Radiology 1990; 177: 713-717177: 713-717u Bhutani MS, Hoffman BJ, van Velse A, Hawes RH. Bhutani MS, Hoffman BJ, van Velse A, Hawes RH. Contrast-enhanced endoscopic ultrasonography with Contrast-enhanced endoscopic ultrasonography with galactose microparticles: SHU508 A (Levovist). galac

5、tose microparticles: SHU508 A (Levovist). Endoscopy 2019;29:635-639Endoscopy 2019;29:635-639靜脈造影劑的類型及組成靜脈造影劑的類型及組成胰腺疾病常規(guī)胰腺疾病常規(guī)EUS的優(yōu)勢與缺乏的優(yōu)勢與缺乏u 優(yōu)勢優(yōu)勢u 更接近病變，可以更好地顯示病變的組織構(gòu)造及更接近病變，可以更好地顯示病變的組織構(gòu)造及病變與周圍臟器和血管的關(guān)系病變與周圍臟器和血管的關(guān)系u 經(jīng)經(jīng)EUS-FNAEUS-FNA獲取細胞獲取細胞/ /組織組織/ /囊液囊液u 對病變的診斷、腫瘤分級對病變的診斷、腫瘤分級/ /分期、術(shù)前定位等能分期、術(shù)前定位

6、等能夠優(yōu)于夠優(yōu)于CT/MRICT/MRIu 缺乏缺乏u 對腫瘤血管等顯示欠佳對腫瘤血管等顯示欠佳u 對一些形狀相近病變，如腫塊型胰腺炎對一些形狀相近病變，如腫塊型胰腺炎vsvs胰腺癌胰腺癌vsvs胰腺神經(jīng)內(nèi)分泌腫瘤、多種胰腺囊性病變等，胰腺神經(jīng)內(nèi)分泌腫瘤、多種胰腺囊性病變等，診斷及良惡性鑒別存在困難診斷及良惡性鑒別存在困難CE-EUS在胰腺疾病診治中的運用在胰腺疾病診治中的運用u 腫塊型胰腺炎與胰腺癌腫塊型胰腺炎與胰腺癌PDAC的鑒別的鑒別D Becker,et al. Gastrointest Endosc,2019CE-EUS在胰腺疾病診治中的運用在胰腺疾病診治中的運用u 腫塊型胰腺炎與胰

7、腺癌腫塊型胰腺炎與胰腺癌PDAC的鑒別的鑒別D Becker,et al. Gastrointest Endosc,2019CE-EUS在胰腺疾病診治中的運用在胰腺疾病診治中的運用u 腫塊型胰腺炎與胰腺癌腫塊型胰腺炎與胰腺癌PDAC的鑒別的鑒別Gheonea et al. BMC Gastroenterology，2019CE-EUS在胰腺疾病診治中的運用在胰腺疾病診治中的運用u 腫塊型胰腺炎與胰腺癌腫塊型胰腺炎與胰腺癌PDAC的鑒別的鑒別Gheonea et al. BMC Gastroenterology，2019CE-EUS在胰腺疾病診治中的運用在胰腺疾病診治中的運用u 腫塊型胰腺炎與胰

8、腺癌腫塊型胰腺炎與胰腺癌PDAC的鑒別的鑒別Gheonea et al. BMC Gastroenterology，2019CE-EUS在胰腺疾病診治中的運用在胰腺疾病診治中的運用u腫塊型胰腺炎與胰腺癌的鑒別腫塊型胰腺炎與胰腺癌的鑒別uResults：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%