超声内镜弹性成像对消化系肿瘤良恶性的鉴别诊断价值  

Value of EUS elastography in differential diagnosis of digestive system benign and malignant tumors

作　　者：张启芳[1] 覃山羽[1] 姜海行[1] 谢明智[1] 

机构地区：[1]广西医科大学第一附属医院消化内科,广西南宁530027

出　　处：《中国内镜杂志》2015年第3期246-250,共5页China Journal of Endoscopy

摘　　要：目的初步探讨超声内镜实时组织弹性成像及弹性应变率比值（SR）对消化系肿瘤病灶良恶性的鉴别诊断价值。方法对26例患者32个消化系统实质性肿瘤病灶进行超声内镜实时弹性成像,采用5分法进行弹性成像评分;测量病灶与周围对照组织的SR,并进行组间比较。结果以评分≤2分的病灶为良性病灶,评分≥3分的病灶为恶性病灶,良恶性病灶组的超声弹性评分对比差异有显著性（P〈0.05）,超声内镜弹性成像诊断消化系恶性肿瘤的敏感性87.0%,特异性88.9%,准确性87.5%。良性病灶组SR范围为0.01-7.33,中位SR为7.39;恶性病灶组SR范围为1.00-47.66,中位SR为20.07,良性病灶组的SR显著低于恶性病灶组的SR,两者的差异有显著性（P〈0.05）。结论消化系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评分及SR有助于消化系肿瘤良恶性的鉴别诊断。EUS弹性成像不能代替FNA,但是可以协助FNA靶向活检,提高活检的阳性率。【Objective】To explore the value of EUS elastography images and strain ratio in differential diagnosis of digestive system benign and malignant tumors. 【Methods】26 patients（32 digestive system tumor lesions）were enrolled, and real-time elastography was carried out. Elastographic images were scored with 5-point scale based on the elastographic patterns. The strain ratio of lesion tissue and surrounding tissue was measured, and it was compared between the benign group and the malignant group.【Results】When the score ≤2 was assigned to benign lesion and ≥3 to malignancy, the score of EUS elastography was different significantly between the benign group and the malignant group（P〈0.05）, and the sensitivity, specificity and accuracy were 87.0%, 88.9%, 87.5%, respectively. The strain ratio of benign lesions and malignant lesions were ranged from 0.01 to 7.33 and 1.00 to 47.66,respectively, the median ratio was 7.39 and 20.07, respectively. The strain ratio of benign lesions was significantly lower than that of malignant ones（P〈0.05）.【Conclusion】There is an apparent difference of elastographic pattern between benign lesions and malignant lesions of digestive system. Real-time EUS elastography and strain ratio may be a promising method for the differentiation of benign and malignant lesions of digestive system. EUS elastography can not take the place of FNA, but, it can help do targeted biopsy of FNA and enhance the positive rate of biopsy.

关 键 词：超声内镜 弹性成像 消化系统肿瘤 应变率比值 诊断 

分 类 号：R735[医药卫生—肿瘤]