Predictive value of contrast-enhanced ultrasound for peripancreatic vascular invasion in pancreatic carcinoma / 中华医学超声杂志（电子版）

ABSTRACT

Objective To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in predicting peripancreatic vascular invasion in pancreatic carcinoma through comparison with the findings on surgical exploration. Methods A total of 94 pancreatic cancer patients (confirmed by pathological examination) were included in this study. The CEUS data were analyzed retrospectively. The enhancement characteristics of lesions were documented. And the peripancreatic vascular invasion were analyzed. The main features of peripancreatic vascular invasion on CEUS were as followings 1) peripancreatic arteries to be embedded, trapped in the tumor or surrounded by tumor, or to have intraluminal infiltration or luminal stenosis. 2)superior mesenteric vein, portal vein to be surrounded by tumor or to be narrow, distorted or occluded. The CEUS findings were compared with postoperative pathological results. Results 94 patients were diagnosed with pancreatic cancer by pathological examination, including 62 cases of pancreatic head carcinoma, 32 cases of pancreatic tail carcinoma. The imaging of contrast-enhanced ultrasound showed 6 cases (6.4%) of high uneven enhancement, 78 cases (83%) of low uneven enhancement, and 10 cases (10.6%) of heterogeneous enhancement in parenchyma phase, respectively. Twenty-five cases (26.6%) of CA invasion were detected by CEUS, while no invasion was observed in 69 cases (73.4%). Compared with pathological findings, the predictive sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS were 63.6%, 79.7%, 84.7%, 56.0%, 88.0%, respectively. Twenty-seven cases (28.7%) of SMA invasion were detected by CEUS, while no invasion were observed in 67 cases (71.3%). Compared with pathological findings, the predictive sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS were 66.6%, 77.6%, 80.2%, 44.0%, 91.0%, respectively. Besides, PV invasion features were found in 27 cases (28.7%), while 67(71.3%) cases were detected without invasion features. Compared with pathological findings, sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS in predicting PV invasion were 86.6%, 94.6%, 98.4%, 96.2%, 94.0%, respectively. Furthermore, CEUS detected SMV invasion in 26 cases (27.6%), while no invasion features in 68 (72.4%) cases. The sensitivity, accuracy, specificity, positive predictive value, negative predictive value for CEUS were 75.0%, 87.2%, 92.4%, 80.7%, 89.7%, respectively. Conclusion Due to its good diagnostic and predictive performance in detecting malignant pancreatic tumors and peripancreatic vascular invasion, CEUS could be served as an effective predictive modality in assessing the resectability of pancreatic carcinoma.