,Slide Title,Body Text,Second Level,Third Level,Fourth Level,Fifth Level,I,ntra-,d,uctal,U,ltra,s,onography,IDUS,Intra-ductal Ultrasonography,Advantages of IDUS,With a finer probe,can get approach to the target site through working channel of the endoscopy,Get clearer images without the interference of air and fat,Probe with higher frequency is enabled with a close distance,Images of high resolution,Advantages of IDUSWith a finer,IDUS vs.routine EUS,The tubular structure of pancreato-billiary duct facilitate the acoustical coupling,Fluid in duct can be used as medium of ultrasound,The diameter of the duct is slightly larger than thant of the probe,Higher frequency,(12-30MHz),Better image resolution,IDUS vs.routine EUSThe tubula,Type of probe,Electronic circular scan,Synchronized double section scan,Mechanical radial scan,Type of probeElectronic circul,Images of normal billiary duct,2-3 layers,Thickness:0.31-0.79mm,Smooth layer with homogenous echo,First layer:hyper-echogenicity,represents the interphase,Second layer:hypo-echogenicity,represents mucosal and muscularis propria layers,Outer layer:hyper-echogenicity,the echo of fat and interface between serosa and other organs,Images of normal billiary duct,Clinical application,Billiary duct,Suspected stone in billiary duct,Differentiation for stenosis,Tumor staging,Pancreatic duct,Differentiation for stenosis,Tumor staging,Showing details of cystic neoplasms,Localization of neuro-endocrine tumors not detcted by EUS,Clinical applicationBilliary d,Suspected stone in CBD,Suspected stone in CBD,CBD stones,N=35,（,with suspected stones,）,Of 21 patients with stones not detected by ERCP,IDUS identified 8,in which 7 were proved by EST,Of 5 patients with suspected stones under ERCP,IDUS identified them as bubbles,IDUS changed the clinical strategies in 13,(37%)patients,Catanzaro,A,Pfau,P,Isenberg,GA,Wong,RC.Clinical utility of intraductal US for evaluation of choledocholithiasis.Gastrointest Endosc 2003;57:648.,N=62,Detect rate of cholangiography:87%,IDUS,combined with cholangiography:97%,CBD stonesN=35（with suspected,IDUS in cholangiocarcinoma and differentiation between benign and malignant stricture,IDUS in cholangiocarcinoma and,Features of cholangiocarcinoma under IDUS,Mass of hypo-echo,infiltrating the surrounding tissue,Heterogeneous echo inside the mass,Serrated or irregular margin,Surface of papillary protrusion,Destruction of normal bile duct,Suspected lymphadenectasis,Features of cholangiocarcinoma,Cholangiocarcinoma,Staging,Detection of early lesions,Identify the margin along the duct,Determine the infiltration of pancreas,Determine the infiltration of portal vein,Determine the infiltration of right hepatic artery,CholangiocarcinomaStaging,Cholangiocarcinoma,N=?,local staging,compared with pT staging,Accuracy of EUS:54%,Accuracy of IDUS:77%,IDUS was especially useful for tumors in middle section of CBD and portal fissure,With poor penetration,unable to make M and N,staging,Unable to perform FNA,Menzel,J,Domschke,W.Intraductal ultrasonography(IDUS)of the pancreato-biliary duct system.Personal experience and review of literature.Eur J Ultrasound 1999;10:105.,Tamada,K,Kanai,N,Tomiyama,T,et al.Prediction of the histologic type of bile duct cancer by using intraductal ultrasonography.Abdom Imaging 1999;24:484.,CholangiocarcinomaN=?,local s,Features of malignant stricture,Mass of hypo-echo,Heterogeneous echo,Irregular margin,Papillary protrusion,Destruction of bile duct,Enlarged LN,Features of malignant strictur,IDUS对胆胰管疾病的应用体会课件,IDUS对胆胰管疾病的应用体会课件,IDUS对胆胰管疾病的应用体会课件,Stricture of bile duct,IDUS,Sensibility:89%,Specificity:50%,Accuracy:76%,Biopsy via percutaneous cholangioscopy,Sensibility:93%,Specificity:100%,Accuracy:95%,Stricture of bile ductIDUSBiop,