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英文誌(2004-)

Journal of Medical Ultrasonics

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2016 - Vol.43

Vol.43 No.Supplement

特別プログラム 消化器
シンポジウム 消化器 Joint(JSUM・AFSUMB・ACUCI Joint Session)(English) 消化器疾患の診断と治療におけるEUSの役割

(S321)

IPMNの壁在結節診断における造影EUSの有用性の検討

Usefulness of Contrast-enhanced endoscopic ultrasonography(CE-EUS)for the diagnosis of mural nodules of IPMNs of the pancreas

大野 栄三郎1, 廣岡 芳樹2, 川嶋 啓揮1, 林 大樹朗1, 桑原 崇通1, 石津 洋二1, 本多 隆1, 葛谷 貞二1, 中村 正直1, 後藤 秀実1

Eizaburo OHNO1, Yoshiki HIROOKA2, Hiroki KAWASHIMA1, Daijuro HAYASHI1, Takamichi KUWAHARA1, Yoji ISHIZU1, Takashi HONDA1, Teiji KUZUYA1, Masanao NAKAMURA1, Hidemi GOTO1

1名古屋大学大学院医学系研究科消化器内科学, 2名古屋大学医学部附属病院光学医療診療部

1Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 2Department of Endoscopy, Nagoya University Hospital

キーワード :

【BACKGROUND】
IPMNs present in various histopathological stages from benign to malignant lesions and the assessment of malignant potentials is still difficult. The International consensus guidelines 2012 for the management of IPMN and MCN states the importance of features of mural nodules and main duct involvement to consider surgery.
(PATIENTS AND METHODS)
Since January, 2001, 218 patients out of 711 with IPMNs examined by both contrast-enhanced(CE)EUS which could exclude the false mural nodule(MN)as avascular structure and Multidetector-row(MD)CT have been surgically treated according to our treatment indications. CE-EUS of the main lesion was performed using 16μL of Sonazoid®. Pathological diagnosis was based on WHO criteria and we classified both high-grade dysplasia and invasive IPMC as malignancy. We defined“mural nodule”as the nodular projection with blood flow signal in CE-EUS and“MPD involvement”as the spread of papillary projections along with the MPD by CE-EUS image. We compared the CE-EUS findings and histopathological findings to assess the diagnostic accuracy of mural nodules and MPD involvement retrospectively.
【RESULTS】
The pathological diagnoses were 108 pts with low-intermediate dysplasia, 53 with high-grade dysplasia and 57 with invasive IPMC. The detection rate of mural nodules of the main lesion by CE-EUS and MDCT were 98.2% and 50.0% respectively. The detection rate of MPD involvement by CE-EUS and MDCT were 50.2% and 34.5% respectively. As comparison with histopathologcal findings, the sensitivity, specificity and accuracy for the diagnosis of MPD involvement were 80.9%,88.9% and 84.4% respectively.
【CONCLUSION】
CE-EUS may allow to exclude mucous clots and detect the true tumorous area in the IPMN lesion precisely. Mural nodules including lower papillary projection along with MPD diagnosed by CE-EUS may represent even very fine epithelial changes in IPMNs.