低级别阑尾黏液性肿瘤与阑尾黏液腺癌超声及超声造影特征分析  

Ultrasound and contrast-enhanced ultrasound features of low-grade appendiceal mucinous tumor and appendiceal mucinous adenocarcinoma

作　　者：汪洪斌 张红霞[1] 何文[1] 杜丽娟[1] 程令刚[1] 张雨康 张萌 Wang Hongbin;Zhang Hongxia;He Wen;Du Lijuan;Cheng Linggang;Zhang Yukang;Zhang Meng(Department of Ultrasound,Beijing Tiantan Hospital,Capital Medical University,Beijing100160,China)

机构地区：[1]首都医科大学附属北京天坛医院超声科,100160

出　　处：《中华医学超声杂志（电子版）》2024年第9期865-871,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨低级别阑尾黏液性肿瘤(LAMN)与阑尾黏液腺癌(AMAC)的超声图像及实验室检查的差异,以提高诊断准确率。方法回顾性分析2009年1月至2023年10月首都医科大学附属北京天坛医院经手术病理证实的阑尾黏液性肿瘤(AMN)患者的超声及超声造影图像,根据术后病理结果分为LAMN及AMAC 2组,采用Fisher精确概率法对比分析2组病例超声图像特征和实验室检查(包括感染指标和肿瘤标志物)的差异。结果最终46例患者纳入研究,其中LAMN组29例,AMAC组17例,LAMN组术前诊断准确率为59%(17/29),而AMAC组为47%(8/17)。2组间超声图像特征中肿块性质(囊性/囊实性)、边界、壁结节、钙化、内部回声、洋葱皮样改变、分隔、与周围组织粘连、超声造影表现、是否合并腹膜假黏液瘤(PMP)差异均具有统计学意义(P均<0.05)。LAMN组72%(21/29)的患者肿块呈囊性,28%(8/29)呈囊实性,而AMAC组100%(17/17)呈囊实性;LAMN组89%(26/29)肿块边界清晰,AMAC组76%(13/17)边界不清晰;LAMN组中14%(4/29)患者有壁结节,AMAC组中88%(15/17)患者有壁结节;LAMN组中7%(2/29)患者囊壁有钙化,AMAC组中59%(10/17)患者囊壁有钙化;LAMN组52%(15/29)患者内部回声均匀,AMAC组100%(17/17)患者内部回声均杂乱;LAMN组34%(10/29)患者肿块内部呈洋葱皮样改变,而AMAC组均无此征象;LAMN组14%(4/29)患者肿块内部有分隔,AMAC组88%(15/17)患者肿块内部有分隔;LAMN组中7%(2/29)患者肿块与周围组织有粘连,AMAC组94%(16/17)患者肿块与周围组织有粘连;LAMN组中7%(2/29)患者肿块超声造影呈高增强,AMAC组82%(14/17)患者肿块超声造影呈高增强,以厚壁结节样高增强为主,余患者肿块均呈无增强;LAMN组中7%(2/29)患者合并PMP,AMAC组65%(11/17)患者合并PMP。AMAC组肿瘤标志物(癌胚抗原、糖类抗原19-9、糖类抗原125、糖类抗原242、神经元特异性烯醇化酶)升高患者例数多于LAMN组,2组间差异均具有统计学意义(P均<0.05)。AMAC�Objective To investigate the difference in ultrasonographic features and laboratory findings between low-grade appendiceal mucinous tumors(LAMN)and appendiceal mucinous adenocarcinoma(AMAC)in order to improve their diagnostic accuracy.Methods The ultrasonographic and contrast-enhanced ultrasound images of patients with appendiceal mucinous tumors confirmed by surgery and pathology at our hospital from January 2009 to October 2023 were retrospectively analyzed.According to the postoperative pathological results,the patients were divided into two groups:patients with LAMNs and those with AMAC.The Fisher exact probability method was used to compare the differences in ultrasound images and laboratory tests(tumor markers and infection indexes)between the two groups.Results Forty-six patients were included in the study,including 29 in the LAMN group and 17 in the AMAC group.Preoperative diagnostic accuracy was 59%in the LAMN group and 47%in the AMAC group.There were significant differences in the characteristics of mass(cystic/cystic-solid),boundary,wall nodule,calcification,internal echo,“onion skin”appearance,septa,adhesion to surrounding tissue,contrast-enhanced ultrasound findings,and whether peritoneal pseudomyxoma(PMP)was combined between the two groups(P<0.05).The mass was cystic in 72%(21/29)of patients in the LAMN group and cystic-solid in 28%(8/29),compared with cystic-solid in 100%(17/17)of patients in the AMAC group.The boundary was clear in 89%(26/29)of patients in the LAMN group and unclear in 76%(13/17)of patients in the AMAC group.Wall nodules were present in 14%(4/29)of patients in the LAMN group and 88%(15/17)in the AMAC group.The capsule wall was calcified in 7%(2/29)of patients in the LAMN group and 59%(10/17)in the AMAC group.Forty-two percent(15/29)of patients in the LAMN group had uniform internal echo,and 100%(17/17)of patients in the AMAC group had chaotic internal echo.Thirty-four percent(10/29)of patients in the LAMN group showed“onion skin”appearance,while no such sign was found in t

关 键 词：超声 超声造影 低级别阑尾黏液性肿瘤 阑尾黏液腺癌 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.9[医药卫生—诊断学]