超声造影在厚壁型胆囊病变鉴别诊断中的价值  

Value of contrast-enhanced ultrasound in differential diagnosis of wall-thickening gallbladder lesions

作　　者：王小立[1] 李玛[1] 黄泽萍[1] Wang Xiaoli;Li Ma;Huang Zeping(Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-senUniversity, Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院超声科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2019年第2期159-163,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省医学科学技术研究基金(A2016128);广东省科技计划项目(2016A020215072)

摘　　要：目的探讨超声造影(CEUS)在厚壁型胆囊病变鉴别诊断中的价值。方法回顾性分析2006年4月至2018年8月在中山大学附属第三医院接受手术治疗的61例厚壁型胆囊病变患者临床资料。其中男36例,女25例;平均年龄(56±11)岁。患者均签署知情同意书,符合医学伦理学要求。患者术前均行CEUS及增强CT检查,以病理学检查结果作为金标准,采用受试者工作特征(ROC)曲线评估二者在厚壁型胆囊病变鉴别诊断中的价值,率的比较采用χ~2检验或Fisher确切概率法。结果病理学检查示胆囊腺癌27例,慢性胆囊炎26例,胆囊腺肌症8例。CEUS检查胆囊癌表现为不均匀增强24例,均匀增强3例;慢性胆囊炎相应为20、6例,胆囊腺肌症相应为7、1例,差异有统计学意义(χ~2=28.40,P<0.05)。胆囊癌患者外壁连续性中断19例,内壁连续性中断21例;慢性胆囊炎患者相应为2、5例;胆囊腺肌症患者仅1例表现为内壁连续性中断,差异有统计学意义(P<0.05)。CEUS、增强CT对厚壁型胆囊病变良恶性诊断的特异度、敏感度、阳性预测值和阴性预测值分别为0.79、0.88、0.77、0.90与0.82、0.85、0.79、0.88。结论 CEUS显示胆囊壁不均匀增强,胆囊内壁或外壁连续性中断有助于胆囊壁增厚病变的良恶性鉴别,CEUS和增强CT诊断价值相当。Objective To evaluate contrast-enhanced ultrasound (CEUS) in the differential diagnosis of wall-thickening gallbladder lesions. Methods Clinical data of 61 patients with wall-thickening gallbladder lesions undergoing surgery in the Third Affiliated Hospital of Sun Yat-sen University from April 2006 to August 2018 were retrospectively analyzed. Among them, 36 patients were male and 25 female, aged (56±11) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received CEUS and enhanced CT before operation. The pathological examination results were taken as the gold standard. The values of CEUS and enhanced CT in the differential diagnosis of wall-thickening gallbladder lesions were evaluated by the receiver operating characteristic (ROC) curve. The rate comparison was conducted by Chi-square test or Fisher's exact test. Results Pathological examination indicated that 27 cases were with gallbladder adenocarcinoma, 26 chronic cholecystitis and 8 gallbladder adenomyosis. Inhomogeneous enhancement and homogeneous enhancement were observed respectively in 24 and 3 patients with gallbladder adenocarcinoma by CEUS, in 20 and 6 patients with chronic cholecystitis, and in 7 and 1 patients with gallbladder adenomyosis, where significant difference was observed (χ^2=28.40, P<0.05). Continuous interruption of external wall and continuous interruption of internal wall were observed respectively in 19 and 21 patients with gallbladder adenocarcinoma, and in 2 and 5 patients with chronic cholecystitis correspondingly, whereas continuous interruption of internal wall was observed in only 1 patients with gallbladder adenomyosis, where significant difference was observed (P<0.05). The specificity, sensitivity, positive and negative predictive values of CEUS and enhanced CT in the differential diagnosis from benign to malignant wall-thickening gallbladder lesions were 0.79, 0.88, 0.77, 0.90 and 0.82, 0.85, 0.79, 0.88, respectively. Conclusions CEUS s

关 键 词：超声检查 介入性 厚壁型胆囊疾病 胆囊癌 诊断 鉴别 

分 类 号：R445.1[医药卫生—影像医学与核医学] R657.4[医药卫生—诊断学]