超声造影在胆囊病灶良恶性鉴别诊断中的价值  

Value of CEUS in differential diagnosis of benign and malignant gallbladder lesions

作　　者：孙鹏飞 钱林学[1] 胡向东[1] 曹雪镔 SUN Peng-fei;QIAN Linxue;HU Xiang-dong(Department of Ultrasound,Beijing Friendship Hospital of Capital Medical University,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院超声科,北京100050

出　　处：《中国医学装备》2023年第2期87-91,共5页China Medical Equipment

摘　　要：目的:探讨超声造影(CEUS)在鉴别胆囊病灶良恶性中的诊断价值。方法:选取医院收治的146例胆囊占位病变患者,根据手术病理结果分为良性组(117例)和恶性组(29例),两组均进行二维超声检查和CEUS检查,比较两组患者的超声及特征,绘制受试者工作特征(ROC)曲线,比较不同诊断模型的诊断效能。结果:146例患者病灶中,恶性29例,良性117例。超声造影在恶性组表现为静脉期低增强、宽基底及胆囊壁不连续,与良性组差异有统计学意义(χ^(2)=85.78,χ^(2)=24.72,χ^(2)=38.32;P<0.05)。恶性组患者年龄及病灶大小显著高于良性组,组间差异有统计学意义(Z=5.97,Z=8.08;P<0.05)。恶性组与良性组的病灶数量、是否浸润肝脏及病变形状比较,差异有统计学意义(χ^(2)=7.64,χ^(2)=47.41,χ^(2)=28.06;P<0.05)。多因素分析显示静脉期低增强和病灶大小是诊断恶性的独立危险因素(OR=33.920,OR=4.268;P<0.05)。回归模型包含静脉期低增强和病灶大小的绘制ROC曲线下面积(AUC)为0.98。当满足2个及以上超声造影阳性特征联合诊断胆囊癌的AUC为0.93。结论:静脉期低增强是鉴别胆囊病变的有效指标,联合超声造影参数或回归模型可提高诊断效能。Objective: To explore the value of contrast-enhanced ultrasound(CEUS) in differential diagnosis of benign and malignant gallbladder(GB) lesions. Methods: This retrospective study included 146 patients with occupied lesion of GB, and they were divided into benign group(117 cases) and malignant group(29 cases) according to the pathological results of surgery. The characteristics of ultrasound and radiography of two groups were compared, and the receiver operating characteristics(ROC) curve was drawn to compare the diagnostic efficiency of different diagnostic model. Results: In the 146 GB lesions, 29 cases(19.86%) were malignant and 117 cases(80.14%) were benign. The CEUS of malignant group appeared low increase in venous phase, wide basement and discontinuous GB wall, and the differences of them between two groups were respectively significant(x~2=85.78, x~2=24.72, x~2=38.32, P<0.05). The ages and the size of lesions of malignant group were significantly higher than those of benign group(Z=5.97, Z=8.08,P<0.05), respectively. The differences of the number of lesions, whether invasion in liver and the shape of lesions between malignant group and benign group were significant(x~2=7.64, x~2=47.41, x~2=28.06, P<0.05), respectively.The results of multiple factor analysis indicated the low increase in venous phase and the size of lesions(OR=33.920,OR=4.268, P<0.05) were independently risk factors in diagnosing malignancy. The area under curve(AUC) of ROC curve of regression model that included the low increase in venous phase and the size of lesions was 0.98. The AUC of combined diagnosis that met 2 and above 2 CEUS positive characteristics was 0.93 for gallbladder carcinoma.Conclusions: Low increase in the venous phase is effective indicators of identifying the lesion of gallbladder, which can improve diagnostic efficiency when combines with the CEUS parameters or regression model.

关 键 词：胆囊 胆囊肿瘤 超声造影(CEUS) 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]