造影增強(qiáng)EUS與胰腺疾病診治課件

1、孫金山孫金山造影增強(qiáng)超聲的發(fā)展造影增強(qiáng)超聲的發(fā)展u 靜脈造影劑最早用于心血管疾病超聲檢查，以增強(qiáng)心腔靜脈造影劑最早用于心血管疾病超聲檢查，以增強(qiáng)心腔及大血管的超聲顯像及大血管的超聲顯像lKeller 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: 570-575u 此后，

2、該項(xiàng)技術(shù)在經(jīng)腹超聲及內(nèi)鏡超聲領(lǐng)域快速發(fā)展此后，該項(xiàng)技術(shù)在經(jīng)腹超聲及內(nèi)鏡超聲領(lǐng)域快速發(fā)展lGoldberg 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: 713-717lBhutani MS, Hoffman BJ, van Velse A, Hawes RH. Contra

3、st-enhanced endoscopic ultrasonography with galactose microparticles: SHU508 A (Levovist). Endoscopy 1997;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(shì)與不足的優(yōu)勢(shì)與不足u 優(yōu)勢(shì)優(yōu)勢(shì)l更接近病變，能夠更好地顯示病變的組織結(jié)構(gòu)及病變與周圍臟器和血管的關(guān)系l經(jīng)EUS-FNA獲取細(xì)胞/組織/囊液l對(duì)病變的診斷、腫瘤分級(jí)/分期、術(shù)前定位等可能優(yōu)于CT/MRIu 不足不足l對(duì)腫瘤血管等顯示欠佳l對(duì)一些形態(tài)相近病變，如腫塊型胰腺炎vs胰腺癌vs胰腺

4、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CE-EUS在胰腺疾病診治中的應(yīng)用在胰腺疾病診治中的應(yīng)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,2001CE-EUS在胰腺疾病診治中的應(yīng)用在胰腺疾病診治中的應(yīng)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,2001CE-EUS在胰腺疾病診治中的應(yīng)用在胰腺疾病診治中的應(yīng)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

5、鑒別Gheonea et al. BMC Gastroenterology，2013CE-EUS在胰腺疾病診治中的應(yīng)用在胰腺疾病診治中的應(yīng)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，2013CE-EUS在胰腺疾病診治中的應(yīng)用在胰腺疾病診治中的應(yīng)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，2013CE-EUS在胰腺疾病診治中的應(yīng)用在胰腺疾病診治中的應(yīng)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lResults：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