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EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2018-01-09 , DOI: 10.1016/j.gie.2017.12.031
Silvia Carrara , Milena Di Leo , Fabio Grizzi , Loredana Correale , Daoud Rahal , Andrea Anderloni , Francesco Auriemma , Alessandro Fugazza , Paoletta Preatoni , Roberta Maselli , Cesare Hassan , Elena Finati , Benedetto Mangiavillano , Alessandro Repici

Background and Aims

EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis–based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs.

Methods

Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve.

Results

Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P < .001]; wSR, 56.6 vs 15.3 [P < .001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P = .0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ± .01) versus neuroendocrine tumor (D = 2.73 ± .03) and a statistical difference for all 3 channels red, green, and blue (P < .0001).

Conclusions

EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.)



中文翻译:

EUS弹性成像(应变比)和基于分形的定量分析对实体胰腺病变的诊断

背景和目标

EUS弹性成像可用于表征实体胰腺病变(SPL),基于分形分析的技术已用于评估肿瘤学中的几何复杂性。这项研究的目的是评估EUS弹性成像(应变比)和分形分析以表征SPL。

方法

前瞻性研究纳入了2015年12月至2017年2月的连续性SPL患者。弹性成像评估包括实质应变比(pSR)和壁应变比(wSR),并使用新型紧凑型US处理器进行。使用计算机程序分析弹性成像图像,以确定3维直方图的分形维数。使用细胞学/组织学/临床综合参考标准来评估敏感性,特异性,阳性预测值,阴性预测值和受体工作曲线下面积。

结果

总体而言,研究了来自100位患者的102个SPL。最终诊断为恶性69例(68%),良性33例。在弹性成像中,与良性SPL相比,恶性肿瘤的pSR和wSR均显着更高(pSR,24.5 vs 6.4 [ P  <.001]; wSR,56.6 vs 15.3 [ P  <.001])。当分别使用pSR和wSR的最佳截止水平分别为9.10和16.2时,灵敏度,特异性,阳性预测值,阴性预测值和受体工作曲线下面积分别为88.4%,78.8%,89.7%,分别为76.9%,86.7%和91.3%,69.7%,86.5%,80%和85.7%。分形分析显示出显着的统计学差异(P 恶性病变的平均表面分形维数(D = 2.66±.01)与神经内分泌肿瘤(D = 2.73±.03)之间的差异,以及红色,绿色和蓝色三个通道的统计差异(P  <。 0001)。

结论

具有pSR的EUS弹性成像和基于分形的分析在表征SPL方面很有用。(临床试验注册号:NCT02855151。)

更新日期:2018-01-09
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