超声内镜弹性成像在消化系黏膜下肿瘤诊断中的价值  

Diagnostic value of EUS elastography in detection of gastrointestinal submucosal tumors

作　　者：邹传鑫[1] 谢明[1] 戴绍军[1] 汤绍迁[1] 

机构地区：[1]荆州市中心医院消化内科,湖北省荆州市434020

出　　处：《世界华人消化杂志》2013年第6期484-489,共6页World Chinese Journal of Digestology

摘　　要：目的:初步探讨消化系黏膜下肿瘤的超声内镜实时组织弹性成像特征及其在良恶性鉴别中的价值.方法:2009-01/2011-10对34例消化系黏膜下肿瘤的患者进行超声内镜实时弹性成像,按照弹性成像5分法对组织弹性成像进行评分,后经手术或内镜下切除获取消化系黏膜下肿瘤病理诊断.结果:34例患者最终诊断为平滑肌瘤6例,脂肪瘤、脂肪肉瘤和神经鞘瘤各1例,胃肠道间质瘤25例,其中间质瘤病理低度危险性12例,中度危险性7例,高度危险性6例.弹性成像模式:良性黏膜下肿瘤的弹性模式多表现为Ⅰ,Ⅱ和Ⅲ型;所有的中高度危险性间质瘤表现为Ⅳ型;弹性成像分级在良、恶性病变之间差异有统计学意义(P<0.001).诊断恶性病灶的敏感度为92.86%,特异度为95.00%,准确率为94.12%.间质瘤和平滑肌瘤的弹性成像没有明显差别.结论:消化系黏膜下肿瘤良恶性组织弹性成像呈不同的图像特征,超声内镜实时组织弹性成像有助于消化系黏膜下肿瘤良恶性病变的鉴别.AIM： To summarize the real-time EUS elastographic patterns of gastrointestinal submucosal tumors （SMTs） and investigate the potential use of EUS elatography for the differentiation between benign and malignant conditions. METHODS： Thirty-four patients who under- went EUS at our department for SMT between January 2009 and October 2011 were enrolled, and real-time elastography was carried out during conventional EUS examination. Elasto- graphic images were scored 1 to 5 based on the elastographic pattern. The final diagnosis was made based on the histopathology of specimens resected by surgery or endoscopy. RESULTS： The 34 lesions were finally diag- nosed as leiomyoma （n = 6）, lipoma （n = 1）, liposarcoma （n -- 1）, neurilemmoma （n = 1）, or gastrointestinal stromal tumors （GISTs） （n = 25）. Among the 25 GIST cases with pathological re- sults, 12 were low-risk GISTs, 7 were moderate- risk GISTs, and 6 were high-risk GISTs. The elatographic patterns of benign SMTs tended to be type I, II or III. All moderate-/high-risk GIST showed an elatographic pattern of type IV. There was a significant difference in elasto- graphic pattern between benign and malignant lesions （P 〈 0.001）. The sensitivity, specificity and accuracy of real-time EUS elastography in the evaluation of malignant lesions were 92.86%, 95.00% and 94.12%, respectively. There was no significant difference in elastographic pattern between GISTs and leiomyoma. CONCLUSION： There is an apparent differ- ence in elastographic pattern between benign and malignant lesions of upper gastrointestinal SMTs. Real-time EUS elastography may be a promising method for the differentiation of benign and malignant lesions of upper gastro- intestinal SMTs.

关 键 词：黏膜下肿瘤 超声内镜 弹性成像 诊断 

分 类 号：R735[医药卫生—肿瘤]