Added Value of Dynamic Contrast-Enhanced Ultrasound Analysis for Differential Diagnosis of Small (≤20 mm) Solid Pancreatic Lesions

IF 2.4 3区医学 Q2 ACOUSTICS

Ultrasound in Medicine and Biology Pub Date : 2025-01-02 DOI:10.1016/j.ultrasmedbio.2024.11.015

Xiu-Yun Lu , Jia-Ying Cao , Sheng Chen , Ying Wang , Li Wei , Wei Gong , Wen-Hui Lou , Yi Dong

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引用次数: 0

Abstract

Objective

To evaluate the added value of dynamic contrast-enhanced ultrasound (DCE-US) analysis in pre-operative differential diagnosis of small (≤20 mm) solid pancreatic lesions (SPLs).

Methods

In this retrospective study, patients with biopsy or surgerical resection and histopathologically confirmed small (≤20 mm) SPLs were included. One wk before biopsy/surgery, pre-operative B-mode ultrasound and contrast-enhanced ultrasound were performed. An ultrasonic system (ACUSON Sequoia, Siemens Medical Solutions, PA, USA) equipped with a 5C1 MHz convex array transducer was utilized. A dose of 1.5 ml SonoVue (Bracco, Italy) was injected as the contrast agent. Time-intensity curves were generated using VueBox software (Bracco) and various DCE-US quantitative parameters were subsequently calculated after curve fitting. Univariate and multivariate logistic regression analysis were utilized.

Results

From August 2020 to November 2023, a total of 76 patients (31 males and 45 females; mean age: 61.9 ± 10.5 y) with 76 small (≤20 mm) SPLs were included. Mean size of the lesions was 16.4 ± 0.4 mm (range: 7–20 mm). Final diagnosis included 37 benign and 39 malignant small SPLs. On B-mode ultrasound, the majority of malignant (37/39, 94.9%) and benign SPLs (30/37, 81.1%) were hypo-echoic lesions with ill-defined borders and irregular shapes (p > 0.05). During the arterial phase of contrast-enhanced ultrasound, most SPLs (59/76, 77.6%) exhibited iso-enhancement when compared with surrounding pancreatic parenchyma. Subsequently, 82.1% (32/39) of malignant SPLs and 35.1% (13/37) of benign SPLs demonstrated wash-out in the venous phase and showed hypo-enhancement in venous and late phases (p > 0.05). Compared with benign SPLs, the time-intensity curves of small malignant SPLs revealed earlier and lower enhancement in the arterial phase, and a faster decline during the venous phase with a decreased area under the curve. Among the quantitative parameters, a lower peak enhancement ratio and higher fall time ratio were more common in small malignant SPLs (p < 0.05). For DCE-US analysis, the combined areas under the curve of significant quantitative parameters was 0.919, with 87.2% sensitivity and 86.5% specificity when differentiating between small malignant and benign SPLs. This result was better than contrast-enhanced computed tomography, which has a sensitivity of 74.4% and a specificity of 75.7%.

Conclusion

DCE-US analysis provides added value for the pre-operative differential diagnosis of small malignant SPLs.

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动态超声增强分析在胰腺小（≤20mm）实性病变鉴别诊断中的价值

目的：探讨动态超声造影（DCE-US）分析在胰腺小（≤20 mm）实性病变术前鉴别诊断中的附加价值。方法：在本回顾性研究中，包括活检或手术切除并经组织病理学证实的小（≤20 mm） SPLs患者。活检/手术前1周行术前b超和增强超声检查。超声系统（ACUSON Sequoia, Siemens Medical Solutions， PA， USA）配备551 MHz凸阵列换能器。注射1.5 ml SonoVue （Bracco, Italy）作为造影剂。采用VueBox软件（Bracco）生成时间-强度曲线，拟合后计算各DCE-US定量参数。采用单因素和多因素logistic回归分析。结果：2020年8月至2023年11月共收治76例患者，其中男31例，女45例；平均年龄：61.9±10.5岁)，包括76例小（≤20 mm）脾细胞瘤。病灶平均大小16.4±0.4 mm（范围7 ~ 20 mm）。最终诊断为37例良性和39例恶性小脾细胞瘤。在b超上，大多数恶性（37/39,94.9%）和良性（30/37,81.1%）为低回声病灶，边界不清，形状不规则（p < 0.05）。在超声造影的动脉期，与周围胰腺实质相比，大多数SPLs（59/76, 77.6%）表现为等强化。82.1%（32/39）的恶性SPLs和35.1%（13/37）的良性SPLs在静脉期表现为冲洗，在静脉期和晚期表现为低增强（p < 0.05）。与良性脾细胞瘤相比，小恶性脾细胞瘤的时间-强度曲线在动脉期增强较早，增强程度较低，在静脉期减弱较快，曲线下面积减小。在定量参数中，小恶性SPLs的峰值增强比和下降时间比均较低（p < 0.05）。DCE-US分析中，显著定量参数曲线下的联合面积为0.919，鉴别小的恶性和良性SPLs的敏感性为87.2%，特异性为86.5%。该结果优于对比增强计算机断层扫描，其敏感性为74.4%，特异性为75.7%。结论：DCE-US分析对小型恶性SPLs的术前鉴别诊断有一定的参考价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ultrasound in Medicine and Biology 医学-核医学

CiteScore

6.20

自引率

6.90%

发文量

325

审稿时长

70 days

期刊介绍： Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. The journal publishes original contributions that demonstrate a novel application of an existing ultrasound technology in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and the interactions between ultrasound and biological systems, including bioeffects. Papers that simply utilize standard diagnostic ultrasound as a measuring tool will be considered out of scope. Extended critical reviews of subjects of contemporary interest in the field are also published, in addition to occasional editorial articles, clinical and technical notes, book reviews, letters to the editor and a calendar of forthcoming meetings. It is the aim of the journal fully to meet the information and publication requirements of the clinicians, scientists, engineers and other professionals who constitute the biomedical ultrasonic community.