肝内胆管细胞癌超声造影和增强CT增强特征的对比研究  

Comparative study of the enhanced features of contrast-enhanced ultrasound and contrast-enhanced CT in intrahepatic cholangiocarcinoma

作　　者：张少飞 张凯[2] 土继政[2] 王博娟 郝磊 朱丽静 王兴华[2] ZHANG Shao-fei;ZHANG Kai;TU Ji-zheng;WANG Bo-juan;HAO Lei;ZHU Li-jing;WANG Xing-hua(Shanxi Medical University,Taiyuan 030001,China;Department of Ultrasound,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,山西太原030001 [2]山西医科大学第二医院超声科,山西太原030001

出　　处：《中国临床医学影像杂志》2022年第2期114-117,共4页Journal of China Clinic Medical Imaging

基　　金：山西省科技厅重点研发计划项目(No.201703D421029)。

摘　　要：目的:对比研究并总结肝内胆管细胞癌超声造影(CEUS)和增强CT(CECT)的增强特征。方法:回顾性分析经超声引导下穿刺活检病理证实的26例患者的30个肝内胆管细胞癌的CEUS和CECT图像,分别比较两种方法的增强时间、动脉期增强模式、增强特点及诊断符合率。增强时间观察始增时间与廓清时间。动脉期的增强模式为1~3级:1级:周边增强;2级:不均匀增强;3级:整体均匀增强。增强特点为动脉期分支状高增强、廓清范围较常规超声范围扩大、门脉期片状强化及延迟期持续向心性强化。结果:30个肝内胆管细胞癌,CEUS始增时间和廓清时间均较早,始增时间均<30 s,廓清时间均<60 s,CECT从30 s开始断层扫描,无法获得病灶准确的始增时间点和廓清时间点。CEUS和CECT动脉期增强模式均以乏血供(1或2级)为主,分别为25个和27个,差异无统计学意义(P>0.05)。CEUS动脉期分支状高增强、廓清范围较常规超声范围扩大的增强特点多于CECT,CECT门脉期片状强化、延迟期持续向心性强化的增强特点多于CEUS,差异均有统计学意义(均P<0.05)。肝内胆管细胞癌的CEUS和CECT诊断符合率的差异无统计学意义(P>0.05)。结论:肝内胆管细胞癌的CEUS和CECT增强特征不同,并且熟练掌握两种方法的增强特征能有效提高诊断效能。Objective:To compare and summarize the enhanced features of contrast-enhanced ultrasound(CEUS)and contrast-enhanced CT(CECT)in intrahepatic cholangiocarcinoma.Methods:The CEUS and CECT images of 30 intrahepatic cholangiocarcinomas from 26 patients confirmed by ultrasound-guided biopsy were retrospectively analyzed,and the enhanced time,enhanced pattern of arterial phase,enhanced features and diagnostic coincidence rate of the two methods were compared.The enhanced time observed the arrive time and wash-out start time.The enhanced patterns of arterial phase were classified into grade 1~3:grade 1,peripheral enhancement;grade 2,unhomogeneous enhancement;grade 3,whole homogeneous enhancement.The enhanced features were divided into branch-like hyper-enhancement of arterial phase,larger wash-out range,patchy enhancement in portal phase and continuous centripetal enhancement in delayed phase.Results:Among the 30 intrahepatic cholangiocarcinomas,the arrive time and wash-out start time of CEUS were both earlier,with the arrive time<30 s and the wash-out start time<60 s.CECT started section scan from 30 s,so the arrive time and wash-out start time of lesions could not be accurately obtained.The enhanced patterns of CEUS and CECT in arterial phase were mainly hypovascular(grade1 or 2),25 and 27 respectively,and the difference was not statistically significant(P>0.05).The enhanced features of branchlike hyper-enhancement in arterial phase and larger wash-out range of CEUS were more than those of CECT,and the patchy enhancement in portal phase and continuous centripetal enhancement in delayed phase of CECT were more than those of CEUS(all P<0.05).There was no significant difference in the diagnostic coincidence rate of CEUS and CECT in intrahepatic cholangiocarcinoma(P>0.05).Conclusion:The enhanced features of CEUS and CECT in intrahepatic cholangiocarcinoma are different,and mastering the enhanced features of the two methods can effectively improve the diagnostic efficiency.

关 键 词：胆管上皮癌 超声检查 多普勒 彩色 体层摄影术 螺旋计算机 

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