超声造影在诊断厚壁型胆囊癌中的应用  

Contrast-Enhanced Ultrasound in the Diagnosis of Thick-Walled Gallbladder Carcinoma

作　　者：郑茹瑜[1] 丁建民[1] 周燕[1] 胡紫月 经翔[1] ZHENG Ruyu;DING Jianmin;ZHOU Yan;HU Ziyue;JING Xiang(Department of Ultrasound,the Third Central Hospital of Tianjin,Tianjin Institute of Hepatobiliary Disease,Tianjin Key Laboratory of Artificial Cell,Artificial Cell Engineering Technology Research Center of Public Health Ministry,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院超声科,天津市肝胆疾病研究所,天津市人工细胞重点实验室,卫生部人工细胞工程技术研究中心,天津300170

出　　处：《中国医学影像学杂志》2020年第3期210-214,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨超声造影对厚壁型胆囊癌的诊断价值。资料与方法选取行二维超声及超声造影检查的胆囊厚壁型占位患者53例,根据病理结果分为恶性组21例,良性组32例,比较两组患者年龄、性别、胆囊大小、病灶厚度、造影增强强度、增强分布、始增时间、达峰时胆囊黏膜面形态以及病灶消退时间的差异,并对超声造影阳性特征进行ROC曲线分析。结果恶性组患者年龄、胆囊宽度及胆囊壁厚度均大于良性组(P<0.05);恶性组超声造影表现为胆囊壁高增强、黏膜面形态不规则、快进(始增时间≤15 s)快退(减退时间≤36 s),与良性组相比差异均有统计学意义(P<0.05);胆囊壁高增强、黏膜面形态不规则、始增时间≤15 s、减退时间≤36 s及联合诊断ROC曲线下面积分别为0.766、0.827、0.702、0.702、0.890,均对厚壁型胆囊癌有较高的诊断价值,当满足3个及以上超声造影阳性特征时联合诊断胆囊癌的敏感度为95.2%,特异度为81.2%,准确度为86.8%。结论超声造影对于厚壁型胆囊癌的诊断及鉴别诊断有一定的临床应用价值。Purpose To investigate the diagnostic value of contrast-enhanced ultrasound in thick-walled gallbladder carcinoma. Materials and Methods Totally 53 patients with thick-walled gallbladder carcinoma and underwent two-dimensional ultrasound as well as contrastenhanced ultrasound examination were divided into malignant group(n=21) and benign group(n=32) according to pathological results. The age, gender, length of gallbladder, width and thickness of gallbladder wall, enhancement level and distribution, the time to initial enhancement, morphology of mucosa to peak enhancement and the time to fading of the lesions between the two groups were analyzed. ROC curve analysis was performed for the contrast-enhanced ultrasound features. Results The age, gallbladder width and gallbladder wall thickness of patients in the malignant group were significantly larger than those in the benign group(P<0.05). Contrast-enhanced ultrasonography in the malignant group showed statistically high enhancement of the gallbladder wall, irregular morphology of the mucosal surface, and rapid progression(initial time≤15 s) and rapid regression(fading time≤36 s) compared with the benign group(P<0.05). The area under the ROC curve of high enhancement, irregular morphology, the time to initial time ≤15 s, fading time ≤36 s and combined diagnosis were 0.766, 0.827, 0.702, 0.702 and 0.890, respectively, which showed they were of the high diagnostic value for thick-walled type of gallbladder carcinoma. The sensitivity, specificity and accuracy of combined diagnosis of gallbladder cancer were 95.2%, 81.2% and 86.8% when three or more positive CEUS characteristics were met. Conclusion Contrast-enhanced ultrasound has obvious advantages in the diagnosis and differential diagnosis of thick-walled type of gallbladder carcinoma, which has certain clinical application value.

关 键 词：胆囊肿瘤 胆囊疾病 超声检查 多普勒 彩色 造影剂 诊断 鉴别 

分 类 号：R735.8[医药卫生—肿瘤] R445.1[医药卫生—临床医学]