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Endoskopie heute 2010; 23(3): 213-220
DOI: 10.1055/s-0030-1262587
Originalarbeit

© Georg Thieme Verlag Stuttgart ˙ New York

Kontrastverstärkter harmonischer Ultraschall bei soliden Pankreasläsionen: Ergebnisse einer Pilotstudie

Contrast-Enhanced Harmonic Endoscopic Ultrasound in Solid Lesions of the Pancreas: Results of a Pilot StudyB. Napoleon1 , 2 , M. V. Alvarez-Sanchetz1 , 2 , R. Gincoul2 , B. Pujol1 , C. Lefort1 , 2 , V. Lepilliez2 , M. Labadie3 , J. C. Souquet2 , P. E. Queneau2 , J. Y. Scoazec4 , J. A. Chayvialle2 , T. Ponchon2
  • 1Departments of Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France,
  • 2Departments of Gastroenterology, Hôpital Edouard Herriot, Lyon, France
  • 3Cabinet d’anatomopathologie, 41, Allée des Cyprès, Limonest, France
  • 4Department of Pathology, Hôpital Edouard Herriot, Lyon, France
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Publication History

Publication Date:
28 September 2010 (online)

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Zusammenfassung

Hintergrund und Studienziele: Die Unterscheidung zwischen einem Adenokarzinom des Pankreas und anderen Pankreasraumforderungen bleibt mit zur Zeit verfügbaren Bildgebungstechniken eine Herausforderung. Diese prospektive Studie hat das Ziel, die Genauigkeit einer neuen Methode der Abbildung des Mikrozirkulationsmusters des Pankreas mithilfe des kontrastverstärkten harmonischen endoskopischen Ultraschalls (CEH-EUS), durchgeführt mit einem neuen Ultraschall-Endoskop Prototyp der Firma Olympus, zu untersuchen. Patienten und Methoden: 35 Patienten mit soliden Pankreasläsionen wurden prospektiv in die Studie einbezogen. Bei allen Patienten war ein konventioneller B-Mode- und ein Power-Doppler-EUS durchgeführt worden. Nach der intravenösen Bolusgabe von 2,4 ml eines Ultraschallkontrastmittels der zweiten Generation (SonoVue) wurde die CEH–EUS mit einem neuen Echoendoskop Prototyp der Firma Olympus (xGF-UCT 180) durchgeführt. Das Mikrozirkulationsmuster wurde mit der Enddiagnose verglichen, die auf der pathologischen Untersuchung von während einer Operation gewonnenen Proben oder der EUS-gestützten Feinnadelaspiration (EUS-FNA) oder durch ein Follow-up von mindestens 12 Monaten beruhte. Ergebnisse: Enddiagnosen waren: 18 Adenokarzinome, 9 neuroendokrine Tumoren, 7 chronische Pankreatitis und 1 Stromatumor. Der Power-Doppler konnte keine Mikrozirkulation darstellen, dies war mit dem „harmonic imaging“ in allen Fällen möglich. Von 18 Läsionen mit einem hypointensen Signal bei der CEH-EUS, waren 16 Adenokarzinome. Die Sensitivität, Spezifität, der negative prädiktive Wert (NPV), der positive prädiktive Wert (PPV) und die Genauigkeit (accuracy) der Hypointensität bei der Diagnostik des Pankreaskarzinoms betrug 89, 88, 89 und 88,5 %, verglichen mit den korrespondierenden Ergebnissen der EUS-FNA von 72, 100, 77, 100 und 86 %. Von 5 Adenomkarzinomen mit falsch negativem Resultat bei der EUS-FNA hatten vier ein hypodenses Echosignal bei der CEH-EUS. Schlussfolgerung: Die CEH-EUS mit dem neuen Prototyp der Firma Olympus stellt zuverlässig das Mikrozirkulationsmuster in soliden Pankreasläsionen dar. Es kann hilfreich bei der Unterscheidung eines Adenokarzinoms von anderen Pankreasraumforderungen sein.

Abstract

Background and study aims: Distinguishing pancreatic adenocarcinoma from other pancreatic masses remains challenging with current imaging techniques. This prospective study aimed to evaluate the accuracy of a new procedure, imaging the microcirculation pattern of the pancreas by contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) with a new Olympus prototype echo endoscope. Patients and methods: 35 patients presenting with solid pancreatic lesions were prospectively enrolled. All patients had conventional B mode and power Doppler EUS. After an intravenous bolus injection of 2.4 ml of a second-generation ultrasound contrast agent (SonoVue) CEH-EUS was then performed with a new Olympus prototype echo endoscope (xGF-UCT 180). The microvascular pattern was compared with the final diagnosis based on the pathological examination of specimens from surgery or EUS-guided fine-needle aspiration (EUS-FNA) or on follow-up for at least 12 months. Results: The final diagnoses were: 18 adenocarcinomas, 9 neuroendocrine tumors, 7 chronic pancreatitis, and 1 stromal tumor. Power Doppler failed to display microcirculation, whereas harmonic imaging demonstrated it in all cases. Out of 18 lesions with a hypointense signal on CEH-EUS, 16 were adenocarcinomas. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of hypointensity for diagnosing pancreatic adenocarcinoma were 89, 88, 88, 89, and 88.5 %, compared with corresponding values of 72, 100, 77, 100, and 86 % for EUS-FNA. Of five adenocarcinomas with false-negative results at EUS-FNA, four had a hypointense echo signal at CEH-EUS. Conclusions: CEH-EUS with the new Olympus prototype device successfully visualizes the microvascular pattern in pancreatic solid lesions, and may be useful for distinguishing adenocarcinomas from other pancreatic masses.

Schlüsselwörter

Endosonografie - kontrastverstärkte harmonische Bildgebung - Feinnadelaspiration - Pankreasraumforderung

Key words

endosonography - contrast-enhanced harmonic imaging - fine-needle aspiration - pancreatic masses

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Prof. Dr. med. H.-J. Schulz

Klinik für Innere Medizin · Sana Klinikum Lichtenberg

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10365 Berlin

Phone: 0 30 / 55 18 22 10

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