超声造影对诊断肝移植术后缺血性胆道损伤预测价值的前瞻性队列研究  

A prospective cohort study of CEUS predictive value in diagnosing ITBLs after liver transplantation

作　　者：李丽[1] 何恩辉[1] 易展雄 奉颖 杜雨晴 钱林学[1] 徐瑞芳[1] Li Li;He Enhui;Yi Zhanxiong;Feng Ying;Du Yuqing;Qian Linxue;Xu Ruifang(Department of Ultrasound,Beijing Friendship Hospital,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》2024年第10期81-85,95,共6页China Medical Equipment

基　　金：首都卫生发展科研专项(首发2020-4-20211)。

摘　　要：目的:探究超声造影(CEUS)对肝移植术后早期肝门处胆管壁增厚患者缺血性胆道损伤(ITBLs)的预测价值。方法:前瞻性纳入2020年6月25日至2022年12月28日于首都医科大学附属北京友谊医院肝移植中心行肝移植术且术后早期肝门部胆管壁增厚的45例患者,所有患者在常规超声初次发现肝门处胆管壁增厚时进行胆道CEUS,并记录胆管壁在各时相的强化模式,根据后续胆道造影的结果将患者分为ITBLs组(15例)和非ITBLs组(30例),对两组患者在CEUS各时相的强化程度进行定性分析并比较,同时评价CEUS对肝移植术后ITBLs的诊断效能。结果:两组患者供肝来源、胆道吻合方式、自身免疫性肝病、肝动脉闭塞(HAO)、排异反应、巨细胞病毒感染及胆管炎情况比较差异均无统计学意义(P>0.05)。两组CEUS动脉期增强模式比较,非ITBLs组患者中25例(占83.3%)为高增强,5例(占16.7%)为等增强,0例低增强或无增强;ITBLs组患者中3例(占20.0%)为高增强,4例(占26.7%)为等增强,8例(占53.3%)为低增强或无增强,两组比较差异有统计学意义(χ^(2)=22.946,P<0.05)。两组延迟期增强模式比较差异无统计学意义(P>0.05)。胆道CEUS提示动脉期低增强或无增强诊断ITBLs的准确率、灵敏度、特异度、阳性预测值及阴性预测值分别为84.4%,53.3%,100%,100%和84.4%。8例CEUS诊断为ITBLs患者,CEUS诊断ITBLs的时间较胆道造影提前了1~6[3.0(1~5)]个月。结论:CEUS可以在胆道出现明显的形态学改变前较准确的预测ITBLs,显著提前ITBLs的诊断时间。Objective:To investigate value of contrast-enhanced ultrasound(CEUS)in predicting ischemic-type biliary lesions(ITBLs)in patients with thickened hilar bile duct wall at early stage after liver transplantation.Methods:A total of 45 patients,who underwent liver transplantation at the Liver Transplantation Center of Beijing Friendship Hospital Affiliated to Capital Medical University from June 25,2020 to December 28,2022,and occurred hilar bile duct wall thickening at early stage after surgery,were prospectively included.CEUS was performed on biliary tract when the thickened hilar bile duct wall was first detected by routine ultrasound,and the enhanced mode of duct wall at each phase was recorded.Subsequently,according to the results of cholangiography,these patients were divided into ITBLs group(15 cases)and non-ITBLS group(30 cases).The enhanced degree of each phase of CEUS of two groups was qualitatively analyzed and compared,and the diagnostic efficacy of CEUS for ITBLs after liver transplantation was evaluated.Results:There were no significant differences in source of liver donor,biliary anastomosis,autoimmune liver disease,hepatic artery occlusion(HAO),rejection,cytomegalovirus infection and cholangitis between the two groups(P>0.05).The compared results of the enhanced mode of CEUS at arterial phase between the two groups indicated that 25 patients(83.3%)were hyper-enhancement,and 5 patients(16.7%)were iso-enhancement,and 0 patient was hypo-enhancement or non-enhancement in non-ITBLS group.The compared results also indicated that 3 patients(20.0%)were hyper-enhancement,and 4 patients(26.7%)were iso-enhancement,and 8 patients(53.3%)were hypo-enhancement or non-enhancement in ITBLs group.The difference of above results between the two groups was statistically significant(χ^(2)=22.946,P<0.000).There was no significant difference between the two groups in the enhanced mode at the late phase(P>0.05).The accuracy,sensitivity,specificity,positively predictive value and negatively predictive value of the prompted hy

关 键 词：超声造影(CEUS) 肝移植 缺血性胆道损伤(ITBLs) 队列研究 

分 类 号：R445.1[医药卫生—影像医学与核医学]