超声造影对胰腺囊实性病变良恶性鉴别诊断价值

Objective To explore the value of contrast-enhanced ultrasound in the differential diagnosis of benign and malignant cystic-solid pancreatic lesions. Methods Sixty-three patients with cystic-solid pancreatic lesions underwent conventional ultrasound and contrast-enhanced ultrasound examinations, and their imaging characteristics were observed. Taking the histopathological results as the gold standard, the coincidence rates of conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of benign and malignant pancreatic tumors were compared. Results Among the 63 cases, 32 were malignant, including 20 cases of ductal adenocarcinoma and 12 cases of solid pseudopapillary neoplasm; 31 were benign, including 18 cases of serous cystadenoma and 13 cases of mucinous cystadenoma. Conventional ultrasound showed that pancreatic ductal adenocarcinoma and solid pseudopapillary neoplasm mainly manifested as smooth lesion margins, regular shapes, uneven echoes in the solid area, presence or absence of blood flow signals, and presence of calcification, etc.; serous cystadenoma and mucinous cystadenoma mainly manifested as clear boundaries, regular shapes, no calcification, and no blood flow signals, etc. Contrast-enhanced ultrasound showed that pancreatic ductal adenocarcinoma was hypoechoic in the enhancement phase and the washout phase, solid pseudopapillary neoplasm was hyperechoic in the enhancement phase and hypoechoic in the washout phase, serous cystadenoma and mucinous cystadenoma were isoechoic or hyperechoic in the enhancement phase and isoechoic or hypoechoic in the washout phase. The coincidence rates of contrast-enhanced ultrasound in the diagnosis of benign and malignant pancreatic tumors (83.87%, 84.37%) were higher than those of conventional ultrasound examination (61.29%, 46.87%) (P < 0.05). Conclusion Contrast-enhanced ultrasound has certain value in the differential diagnosis of benign and malignant cystic-solid pancreatic lesions.

目的 探讨超声造影对胰腺囊实性病变良恶性的鉴别诊断价值。方法 ６ ３例胰腺囊实性病变患者均行常规超声及超声造影检查， 观察其影像学特点； 并以组织病理学结果为金标准， 比较常规超声和超声造影检查诊断良、 恶性胰腺肿瘤的符合率。结果 ６ ３例中恶性３ ２例， 其中导管腺癌２ ０例， 实性假乳头状肿瘤１２例； 良性３ １例， 其中浆液性囊腺 瘤１ ８例， 黏液性囊腺瘤１ ３例； 常规超声显示胰腺导管腺癌和实性假乳头状肿瘤主要表现为病灶边缘光整、 形态规则、 实性区域回声不均匀、 血流信号有或无、 有钙化等， 浆液性囊腺瘤和黏液性囊腺瘤主要表现为边界清晰、 形态规则、 无钙化、 无血流信号等； 超声造影显示胰腺导管腺癌在增强期和减退期为低回声， 实性假乳头状肿瘤在增强 期 为 高 回 声， 减 退 期 为低回声， 浆液性囊腺瘤和黏液性囊腺瘤在增强期为等回声或高回声， 减退期为等回声或低回声； 超声造影诊断良、 恶性胰腺肿瘤的符合率（ ８ ３．８７％、 ８４．３７％） 高于常规超声检查（ ６ １．２９％、 ４６．８７％） （ Ｐ＜０ ．０５） 。结 论 超 声 造 影 在 胰 腺 囊 实 性病变良恶性的鉴别诊断中有一定价值。