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1、Intra-ductal Ultrasonography, IDUS,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,IDU
2、S 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,Type of probe,Electronic cir
3、cular scan Synchronized double section scan Mechanical radial scan,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
4、layers Outer layer: hyper-echogenicity, the echo of fat and interface between serosa and other organs,Clinical application,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 wi
5、th 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 cho
6、langiography : 87% IDUS combined with cholangiography: 97%,IDUS in cholangiocarcinoma and differentiation between benign and malignant stricture,Features of cholangiocarcinoma under IDUS,Mass of hypo-echo, infiltrating the surrounding tissue Heterogeneous echo inside the mass Serrated or irregular m
7、argin Surface of papillary protrusion Destruction of normal bile duct Suspected lymphadenectasis,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 rig
8、ht hepatic artery,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, Domsch
9、ke, 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 Imag
10、ing 1999; 24:484.,Features of malignant stricture,Mass of hypo-echo,Heterogeneous echo,Irregular margin,Papillary protrusion,Destruction of bile duct,Enlarged LN,Stricture of bile duct,IDUS Sensibility: 89% Specificity: 50% Accuracy: 76%,Biopsy via percutaneous cholangioscopy Sensibility: 93% Specificity: 100% Accuracy: 95%,