腔内超声联合心腔内超声导管显示壶腹周围肿瘤的可行性研究
这是一项两阶段离体可行性研究，共纳入25例胰腺标本，前10例用于建立并标准化成像方案，后15例用于评估技术可行性。将心腔内超声导管置入胰管、胆总管或腔外，行B模式成像与剪切波弹性成像，15例中12例导管置入成功，可定性显示壶腹周围肿瘤；正常胰腺实质剪切波速度中位数1.58 m/s、弹性模量7.6 kPa，但肿瘤组织弹性成像测量欠佳。结论认为该技术可行，肿瘤弹性成像仍需技术改进与在体验证。
要点
- 离体标本中ICE导管经胰管或胆总管置入多可成功，能定性显示壶腹周围肿瘤。
- 肿瘤>4 cm或术后解剖不清时置管失败，可尝试腔外成像补救。
- 正常胰腺实质剪切波速度1.58 m/s、弹性模量7.6 kPa，可作为参考。
核心结论
- IDUS联合ICE导管在离体条件下对壶腹周围肿瘤的B模式定性显示可行，并可评估胰腺实质弹性。
研究设计与样本
- 两阶段离体可行性研究，共25例胰腺标本，前10例建立并标准化成像方案，后15例评估技术可行性。
- 导管置入胰管、胆总管或腔外，行B模式与剪切波弹性成像（SWE）。
- 评估指标包括肿瘤显示率、置管成功率、正常与肿瘤组织的SWE测量值及图像质量。
关键影像表现/征象
- B模式成像可定性显示壶腹周围肿瘤，腔外成像在其中1例置管失败病例中成功显示肿瘤。
- 导管置入失败主要与肿瘤体积大（>4 cm）或手术切除后胆胰管解剖无法辨认有关。
诊断标准与关键数值
- 15例中12例ICE导管置入成功。
- 正常胰腺实质剪切波速度中位数1.58 m/s，弹性模量中位数7.6 kPa。
- 肿瘤组织SWE测量欠佳，可能源于离体组织变异及导管反复使用中的应变。
临床应用与阅片要点
- 离体结果提示，对小壶腹周围病灶可尝试经胰管或胆管腔内超声补充显示。
- 肿瘤较大或术后解剖不清时置管困难，可考虑腔外扫查路径。
- 肿瘤SWE测值目前不可靠，解读弹性结果需谨慎，不宜单独用于定性。
局限性
- 离体研究，样本量有限（25例），需在体验证。
- 肿瘤组织弹性成像测量不理想，技术尚需改进。
- 置管失败与肿瘤大小及术后解剖改变相关，可能限制适用范围。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: Early detection of pancreatic cancer is crucial for survival, but detecting smalllesions remains challenging. Intraductal Ultrasound (IDUS) using intracardiac echocardiography (ICE) catheters for B-mode and Shear-Wave Elastography (SWE) potentially offers improved visualization and characterization of small tumors. This study assesses the feasibility of IDUS using ICE catheters to detect and visualize periampullary tumors in surgically resected specimens.
METHODS: In this two-phase ex-vivo feasibility study, 25 pancreatic specimens were included, of which the first 10 were used to establish and standardize the imaging protocol, followed by technical feasibility evaluation in the remaining 15 specimens. Catheters were introduced into the pancreatic duct, common bile duct, or positioned extraductally to enable tumor visualization with B-mode imaging and shear-wave elastography (SWE). Tumor visualization rates, catheter insertion success, SWE measurements in normal and tumor tissue, and image quality were assessed.
RESULTS: ICE catheter insertion was successful in 12 of 15 specimens; unsuccessful access was primarily related to large tumor size (>4 cm) or unidentifiable ductal anatomy following surgical resection. However, extraluminal imaging successfully visualized tumors in one of these cases. Median shear-wave speed and elastic modulus for normal pancreatic parenchyma were 1.58 m/s and 7.6 kPa, respectively. SWE measurements in tumor tissue were suboptimal, likely due to ex-vivo tissue variability and catheter strain during repeated use.
CONCLUSION: IDUS with ICE is feasible for qualitative B-mode visualization of periampullary tumors and enables SWE assessment of pancreatic parenchyma in an ex-vivo setting. Reliable elastography of tumor tissue remained challenging, indicating the need for further technical refinement and in-vivo validation.
引用
- Ramaekers M, Fernandes CD, Li X, et al. Visualizing Periampullary Tumors with Intraductal Ultrasound utilizing an Intracardiac Echocardiography Catheter: A Feasibility Study. Ultrasound Med Biol. 2026. PMID: 42069485. doi:10.1016/j.ultrasmedbio.2026.02.022
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。