超声内镜弹性成像和应变率在胰腺实性肿块
良恶性鉴别诊断中的价值初探

doi:10.12117/jccmi.2019.03.009

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摘要目的：初步探讨超声内镜弹性成像评分和应变率比值在胰腺实性肿块的良恶性鉴别诊断中的价值。方法：将具有胰腺实性肿块的38例患者纳入研究，通过超声内镜弹性成像检查，获得弹性成像评分和应变率比值，对照诊断标准，计算弹性成像评分和应变率比值对于胰腺实性肿块良恶性的诊断准确性、灵敏度和特异度等，并且使用受试者工作特征曲线来确定应变率比值的截断值。结果：在38例胰腺实性肿块的患者中，手术或超声内镜引导下穿刺病理等显示良性肿块有12例（炎性肿块10例、无功能性内分泌瘤2例），恶性的肿块26例（胰腺癌）。超声内镜弹性成像评分诊断胰腺恶性实性肿块的准确性、灵敏度和特异度分别为89.5%、92.3%、83.3%。良性组的弹性应变率比值平均为（11.64±13.47），恶性组的平均为（34.04±18.33），两组弹性应变率比值有显著统计学差异（P<0.05），我们通过受试者工作特征曲线最终确定弹性应变率比值的临界值为22.46，以22.46为截断值，诊断的敏感性为79.6％，特异性91.%。弹性成像评分联合应变率比值共同诊断时准确性、灵敏度、特异度和阳性预测值以及阴性预测值分别高达94.7%、96.2%、91.7%、96.2%、91.7%。结论：超声内镜弹性成像评分在胰腺实性肿块的良恶性鉴别中具有较高的准确性，联合弹性应变率比值可提高其诊断价值，为超声内镜检查及胰腺实性肿块提供了一项新的诊断方法。

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	叶颖剑
	刘波
	李琼霞
	李秀梅
	张娟

关键词 ：胰腺肿瘤, 腔内超声检查

Abstract：Objective: To evaluate the accuracy of the endoscopic ultrasonography(EUS) elastography score and strain ratio(SR) in the differential diagnosis of benign and malignant solid pancreatic lesions. Methods: A total of 38 patients with solid pancreatic lesions identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and SR in differentiating malignant from benign lesions. The semiquantitative score of elastography was represented by the SR method. Sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy were calculated by comparing the diagnoses made by elastography, SR and final diagnoses. According to Young’s modulus, a receiver operating characteristic(ROC) curve was drawn, and it used to identify the value of strain ratio for differential diagnosis of solid pancreatic lesions. Result: Elastography was successfully performed in all patients and there were no procedure related complications. Twenty-six patients were finally diagnosed with pancreatic carcinoma, 2 with benign endocrine tumor and 10 with focal pancreatitis. According to our diagnostic criteria of elastography, the overall accuracy of EUS elastography for the differential diagnosis of focal pancreatic masses was 89.5%(34/38), with a sensitivity, specificity of 92.3%, 83.3%, respectively. Malignant lesions had significantly higher median SR(34.04±18.33) than benign lesions(11.64±13.47). The best cut-off level of SR to obtain the maximal area under the curve was 22.46 with a sensitivity of 79.6%, specificity of 91% through ROC curve. Combined elastography to SR resulted in an accuracy of 94.7%, sensitivity of 96.2%, specificity of 91.7%, PPV of 96.2%, and NPV of 91.7% for the diagnosis of solid pancreatic lesions. Conclusion: EUS elastography has a relatively high accuracy for the differentiation of benign and malignant pancreatic lesions, combined with SR would increase the accuracy.

Key words： Pancreatic neoplasms Endosonography

收稿日期: 2018-04-10

PACS:	Ｒ735.9
	Ｒ445.1

通讯作者: 刘波，湖北医药学院附属襄阳市第一人民医院消化科，441000。E-mail：490767656@qq.com

作者简介: 叶颖剑（1988-），女，湖北南漳人，主治医师。E-mail：yeyingjian88@126.com

引用本文:

叶颖剑，刘波，李琼霞，李秀梅，张娟. 超声内镜弹性成像和应变率在胰腺实性肿块良恶性鉴别诊断中的价值初探[J]. 中国临床医学影像杂志, 2019, 30(3): 183-186.
YE Ying-jian, LIU Bo, LI Qiong-xia, LI Xiu-mei, ZHANG Juan. Endoscopic ultrasonography elastography score and strain ratio in the differential diagnosis of benign and malignant solid pancreatic lesions. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(3): 183-186.

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http://www.jccmi.com.cn/CN/10.12117/jccmi.2019.03.009 或 http://www.jccmi.com.cn/CN/Y2019/V30/I3/183

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