超声造影在胆固醇性息肉和胆囊腺瘤中的鉴别诊断价值  

Value of Contrast-enhanced Ultrasound in Differential Diagnosis between Cholesterol Polyp and Gallbladder Adenoma

作　　者：朱连华 费翔 韩鹏 李楠 梁舒媛 罗渝昆 ZHU Lianhua;FEI Xiang;HAN Peng;LI Nan;LIANG Shuyuan;LUO Yukun(Department of Ultrasound,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心超声诊断科,北京100853

出　　处：《中国医学科学院学报》2021年第3期350-356,共7页Acta Academiae Medicinae Sinicae

摘　　要：目的比较超声造影(CEUS)与常规超声在胆固醇性息肉和胆囊腺瘤鉴别诊断中的准确性。方法回顾性分析2019年1月至2020年10月在中国人民解放军总医院第一医学中心行胆囊切除术的136例胆囊息肉样病变(GPLs)患者的临床资料,比较胆固醇性息肉与胆囊腺瘤的超声及CEUS图像特征,评估CEUS的诊断准确性。结果136例GPLs患者中,胆固醇性息肉患者95例,胆囊腺瘤患者41例。息肉最大径(Z=-5.189,P<0.001)、血流信号(χ^(2)=33.630,P<0.001)、血管性基底部宽度(Z=-7.366,P<0.001)、息肉开始增强时间(χ^(2)=22.487,P<0.001)、动脉期增强强度(χ^(2)=44.371,P<0.001)、息肉血管形态(χ^(2)=53.814,P<0.001)、胆囊壁完整性(χ^(2)=13.277,P=0.001)在胆固醇性息肉和胆囊腺瘤间的差异均有统计学意义。CEUS诊断胆囊腺瘤的敏感性、特异性和准确性分别是85.37%、89.47%和88.24%,曲线下面积为0.874。结论CEUS能有效鉴别胆固醇性息肉和胆囊腺瘤,有助于GPLs患者选择合适的治疗方式。Objective To compare the performance of contrast-enhanced ultrasound(CEUS)and ultrasound(US)in the differential diagnosis between cholesterol polyps and gallbladder adenomas.Methods A total of 136 patients with gallbladder polyp lesions(GPLs)and undergoing cholecystectomy in the First Medical Center of Chinese PLA General Hospital from January 2019 to October 2020 were retrospectively analyzed.All the patients underwent US and CEUS examinations before cholecystectomy.US and CEUS images of cholesterol polyps and gallbladder adenomas were compared for the evaluation of the performance of CEUS in the diagnosis of gallbladder adenomas.Results The 136 cases of GPLs included 95 cases of cholesterol polyps and 41 cases of gallbladder adenomas.Cholesterol polyps and gallbladder adenomas showed significant differences in the maximum size of GPLs(Z=-5.189,P<0.001),polyp blood flow signal(χ^(2)=33.630,P<0.001),vascular stalk width(Z=-7.366,P<0.001),polyp enhancement time(χ^(2)=22.487,P<0.001),enhancement intensity in arterial phase(χ^(2)=44.371,P<0.001),polyp vascular morphology(χ^(2)=53.814,P<0.001)and gallbladder wall integrity(χ^(2)=13.277,P=0.001).The sensitivity,specificity and accuracy of CEUS in distinguishing gallbladder adenomas from cholesterol polyps were 85.37%,89.47%and 88.24%,respectively,and the area under the curve was 0.874.Conclusion CEUS can effectively distinguish gallbladder adenomas from cholesterol polyps and help patients with GPLs to select the appropriate treatment.

关 键 词：胆囊疾病 息肉 腺瘤 超声检查 超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学]