超声造影在胆囊腺瘤及腺瘤癌变鉴别诊断中的应用价值  

The role of contrast-enhanced ultrasound in the differentiation between gallbladder adenoma and carcino- ma developing from gallbladder adenoma

作　　者：孙丽萍[1] 徐辉雄[1] 刘琳娜[1] 郭乐杭[1] 张一峰[1] 徐军妹[1] 章晶[1] 刘畅[1] 

机构地区：[1]同济大学附属第十人民医院暨上海市第十人民医院超声医学科同济大学影像临床医学中心,200072

出　　处：《中华肝胆外科杂志》2013年第3期204-207,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：教育部新世纪优秀人才支持计划项目（NCET-06-0723）;上海市卫生局重点项目（20114003）

摘　　要：目的探讨超声造影在胆囊腺瘤及腺瘤癌变鉴别诊断中的应用价值。方法对经手术病理证实的胆囊腺瘤（19例）及腺瘤癌变（9例）患者超声造影增强特征进行回顾性分析，记录病灶增强时间、增强水平、增强形态、病变邻近胆囊壁层次结构的完整性，并结合病理结果评价各指标诊断胆囊腺瘤及腺瘤癌变的价值。结果两组病例超声造影增强水平无差别。胆囊腺瘤组病灶开始增强时间、达峰时间均早于腺瘤癌变组[（13．11±3．63）s比（18．11±3．26）s；（17．36±3．95）s比（24．56±4．36）S，P〈0．01]。两组病灶增强变等时间差异无统计学意义[（27．79±11．88）S比（32．33±5．74）s]。腺瘤癌变组病灶变低时间早于腺瘤组[（55．56±15．4）S比（91．00±34．25）S，P〈0．01]。胆囊腺瘤组胆囊周围肝实质开始增强时间早于腺瘤癌变组[（16．63±4．66）S比（22．78±5．29）S，P〈0。053。应用受试者工作特征曲线（ROC）发现，病灶增强达峰时问〉20S诊断胆囊腺瘤癌变的敏感性为89％，特异性为85％。19例胆囊腺瘤患者均表现为均匀增强，而9例腺瘤癌变患者有3例表现为不均匀增强，6例表现为均匀增强，差异有统计学意义（P〈O．01）。超声造影可清晰显示胆囊壁结构，19例胆囊腺瘤病变邻近的胆囊壁结构均完整、清晰。9例腺瘤癌变病变邻近的胆囊壁结构有6例不清晰，5例胆囊壁不完整，差异有统计学意义（P〈0．01）。结论超声造影有助于胆囊腺瘤及腺瘤癌变的鉴别诊断。病灶增强达峰时间、增强形态及病变邻近胆囊壁层次结构的破坏有助于胆囊腺瘤及腺瘤癌变的鉴别诊断。Objectives To investigate the role of contrast-enhanced ultrasound in the differentia- tion between gallbladder adenoma and carcinoma developing from gallbladder adenoma. Methods The data from 28 patients who received contrast-enhanced ultrasound （19 patients with gallbladder adeno- ma and 9 patients with gallbladder carcinoma developing from gallbladder adenoma） were retrospec- tively analyzed. We analyzed the contrast enhancement characteristics of the initial enhancement time, the enhancement level, enhanced morphology and the integrity of gallbladder wall adjacent to the le- sions. All the lesions were confirmed by histopathology. Results The time to initial enhancement and the time to peak enhancement were significantly shorter in patients with gallbladder adenoma than in patients with gallbladder carcinoma developing from gallbladder adenoma [（13.11±3.63） s vs. （18.11±3.26）s, （17.36±3.95）s vs. （24.56±4.36）s, all P〈0.01]. The time to iso-enhancement, however, showed no significant differences. The time to hypo-enhaneement and enhancement time of the liver were significantly shorter in patients with gallbladder carcinoma developing from gallbladder adenoma than in patients with gallbladder adenoma [（55.56 ± 15.4） s vs. （91.00± 34. 25） s, P〈0.01,（16. 63±4.66）s vs. （22. 78±5.29）s, P〈0. 05]. Using ROC curve, the time to peak enhance- ment value greater than 20 s had a sensitivity of 89 % and a specificity of 85% for detecting gallbladder carcinoma developing from gallbladder adenoma. The enhancement level showed no significant differ-ence between the two groups. Inhomogeneous enhancement was found in 3 （33 %） gallbladder cancer developing from gallbladder adenoma and none （0/19） in gaflbladder adenoma （P〈0.01）. Destruction of the integrity of gallbladder wall was found in 6 （66.7%） gallbladder carcinoma developing from gallbladder adenoma and none （0/19） in gallbladder adenoma （P〈0.01）. Conclusions Contrast-en- hanced ultrasound is use

关 键 词：胆囊肿瘤 超声检查 

分 类 号：R735.8[医药卫生—肿瘤]