,Slide Title,Body Text,Second Level,Third Level,Fourth Level,Fifth Level,Advances of IDUS in Diagnosis for Billiary Diseases,Xiaoping Zou,Department of Gastroenterology,Nanjing Drum Tower Hospital,Nanjing University School of Medicine,Nanjing,China,迁泪苗纬笼咏钙鹤让林根阴淡沦蔷亦零跃蛹未椽锅馒酗阐枷帐瘦秆怕话痊-IDUS对胆胰管疾病的应用体会InterventionalEUS,Advances of IDUS in Diagnosis,I,ntra-,d,uctal,U,ltra,s,onography,IDUS,创椅螟司榷卢贴恋价炮澳妄埠磁吻扎毛迅怖江积愉仔展部编叁村卖恋屑瞥-IDUS对胆胰管疾病的应用体会InterventionalEUS,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,夹少床洱呵剑芒孜今忌痉轿砖媳蝇件玲牢永刁鼎赖施顾喻欲汁学矾洽傈钞-IDUS对胆胰管疾病的应用体会InterventionalEUS,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,晨庆妊叁淌航勋婿依稽沽敖伊肩铜贸指戳檬涯剪河矣抚结锭双早冀展蛤褐-IDUS对胆胰管疾病的应用体会InterventionalEUS,IDUS vs.routine EUSThe tubula,Type of probe,Electronic circular scan,Synchronized double section scan,Mechanical radial scan,枝截姿寥明柿澄量捶捆着鸟矫辈米妒舍庆杠柴烘氰琳薯役蝶脸窃磐管练怎-IDUS对胆胰管疾病的应用体会InterventionalEUS,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,投唐咱聪墩蟹谚狸痰简链兹矗哄渴馈朽暗液愿妮萧苛屉蔡盏榨掠构霍九村-IDUS对胆胰管疾病的应用体会InterventionalEUS,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,奠怜统丈姬眷廓茬纪束某宠竿渍郑荧脓呜灾瘪畔择宿诞赣囚瘫根踢蘸噶禄-IDUS对胆胰管疾病的应用体会InterventionalEUS,Clinical applicationBilliary d,Suspected stone in CBD,犯毫酵彦另竣坏持斤可窿棵翌夜申刹臂松侩墟恬迈铣上锹张郑巡阴醚茸侈-IDUS对胆胰管疾病的应用体会InterventionalEUS,Suspected stone in CBD犯毫酵彦另竣坏持,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%,返综呸吩陛妥畔沁赌嘶迅浮衔俏蓟惮雾讨庚狰纺揪还事碱蕉屿轩作应斥圭-IDUS对胆胰管疾病的应用体会InterventionalEUS,CBD stonesN=35（with suspected,IDUS in cholangiocarcinoma and differentiation between benign and malignant stricture,馁袖息敛羚赐遇萄训锻睁果瓣品呆椅第锈柳平堪席汤暴好柜拈匈攫獭链秤-IDUS对胆胰管疾病的应用体会InterventionalEUS,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,于交储蝉审抽川亨臀宙漱致铣劫钢野彻酣族追祭篙胜眉扦机沽吁庶闽送狮-IDUS对胆胰管疾病的应用体会InterventionalEUS,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,傍损斜他匿量暇髓踏安货真柯立户骑虱涉捷虑究裂哉蠢诲皋挛犀做绿娃松-IDUS对胆胰管疾病的应用体会InterventionalEUS,CholangiocarcinomaStaging傍损斜他匿,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.,顿瘦所捆瀑邀燎杨躬驼姻颈拘团贰殊散窘油闪集瞅暑素递篙宅品瓜徊福诱-IDUS对胆胰管疾病的应用体会InterventionalEUS,CholangiocarcinomaN=?,local s,Features of malignant stricture,Mass of hypo-echo,Heterogeneous echo,Irregular margin,Papillary protrusion,Destruction of bile duct,Enlarged LN,债忌毖臻屡逛研囊询河希我镰称短导阂昭酶炮趟酚玉冷骤茎瘟霄眷昨劣叁-IDUS对胆胰管疾病的应用体会InterventionalEUS,Features of malignant strictur,国两洽弊容牙讯少搪燎穿镍停碘很动殉圾阔碟烷连乃抄杜珐闯盈裂圃伊键-IDUS对胆胰管疾病的应用体会InterventionalEUS,国两洽弊容牙讯少搪燎穿镍停碘很动殉圾阔碟烷连乃抄杜珐闯盈裂圃,绵密浙汾肝死逝粱铡朋璃鞭辑孽咆撑撂深炙诽纷榆恼盲郴闰惺徘娠柬讣糙-IDUS对胆胰管疾病的应用体会InterventionalEUS,绵密浙汾肝死逝粱铡朋璃鞭辑孽咆撑撂深炙诽纷榆恼盲郴闰惺徘娠柬,考硬唾枷效蓑啡佃商泄状啤辗番的忽墓沟示晃知茬芜复陶锋蚂刹腆盒莱臼-IDUS对胆胰管疾病的应用体会InterventionalEUS,考硬唾枷效蓑啡佃商泄状啤辗番的忽墓沟示晃知茬芜复陶锋蚂刹腆盒,Stricture of bile duct,IDUS,Sensibility:89%,Specifi