Application Of Contrast-enhanced Ultrasound In The Differential Diagnosis Of Pancreatic Cancer And Mass Type Chronic Pancreatitis

Purpose:To observe the features of contrast-enhanced ultrasound of pancreatic cancer and mass type chronic pancreatitis and evaluate the value of contrast-enhanced ultrasound in the diagnosis and differential diagnosis of pancreatic cancer and mass type chronic pancreatitis.Materials and methods:A total of 51 cases was collected from January 2016 to December 2017 for patients with pancreatic cancer and mass type chronic pancreatitis,and these patients were all underwent conventional ultrasound,contrast-enhanced ultrasound and enhanced CT examination.As the gold standard pathological diagnosis confirmed 40 cases of pancreatic cancer and 11 cases of mass type chronic pancreatitis.The conventional ultrasound and CEUS features of pancreatic cancer and mass type chronic pancreatitis are observed and quantitative analysis by time-intensity curve(TIC)is made to improve the objectivity and accuracy of contrast-enhanced ultrasound in the differential diagnosis of both.Results:Fifty-one patients were confirmed by pathology,including 40 pancreatic cancer and 11 mass type chronic pancreatitis.(1)The maximum diameter of pancreatic cancer and mass type chronic pancreatitis,the attenuation of posterior echo,and the difference of pancreatic duct lesions were statistically significant(P<0.05).Age,gender,lesion location,tumor morphology,boundary,echo,blood flow signal and the surrounding blood vessels have no statistical significance(P>0.05).(2)In 40 cases of pancreatic cancer,37 cases showed heterogeneously low enhancement of both EPPP and DPPP;two cases showed heterogeneously high enhancement of EPPP,while DPPP showed low enhancement;one case showed the EPPP was equal enhancement,while DPPP low enhancement.Nine out of eleven cases of mass type chronic pancreatitis showed equal enhancement of both EPPP and DPPP,and two cases of EPPP and DPPP showed low enhancement.(3)TIC parameters of pancreatic cancer rise time(RT)were greater than that of mass type chronic pancreatitis.The peak intensity(PI),transit time(TT)and area under the curve(AUC)were all less than those of mass type chronic pancreatitis,with statistical differences(P<0.05);the time to peak(TTP)difference was not statistically significant(P>0.05).(4)The diagnostic accuracy of contrast-enhanced ultrasound was superior to that of conventional ultrasound,and there was a statistically significant difference between the two(P=0.028).There was no significant difference between CEUS and the contrast-enhanced CT(P=0.750).The sensitivity,specificity,positive predictive value,and negative predictive value of CEUS were respectively 90.0%,81.8%,94.7%,and 69.2%,which were higher than those of conventional ultrasound.Conclusion:1.In the differential diagnosis of pancreatic cancer and mass type chronic pancreatitis,contrast-enhanced ultrasound is superior to conventional ultrasound and has similar diagnostic accuracy with enhanced CT.2.CEUS quantitative analysis can provide more accurate and objective basis for the diagnosis and differential diagnosis of pancreatic cancer and mass type chronic pancreatitis.