超声造影鉴别诊断胆囊息肉样病变性质的多中心研究  

Contrast-Enhanced Ultrasound in the Differential Diagnosis of Gallbladder Polypoid Lesions:A Multicenter Study

作　　者：贾丽刚 费翔[1] 经翔[3] 李明星 聂芳[5] 蒋栋 唐少珊[7] 张巍[8] 丁红 宋涛[10] 周琦[11] 张蓓 孙志霞[13] 马晓娟[14] 何年安 李芳 祝英乔[17] 程文[18] 罗渝昆[1] JIA Ligang;FEI Xiang;JING Xiang;LI Mingxing;NIE Fang;JIANG Dong;TANG Shaoshan;ZHANG Wei;DING Hong;SONG Tao;ZHOU Qi;ZHANG Bei;SUN Zhixia;MA Xiaojuan;HE Nianan;LI Fang;ZHU Yingqiao;CHENG Wen;LUO Yukun(Department of Ultrasound,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;不详)

机构地区：[1]解放军总医院第一医学中心超声诊断科,北京100853 [2]解放军医学院,北京100853 [3]天津市第三中心医院超声科,天津300170 [4]西南医科大学附属医院超声科,四川泸州646000 [5]兰州大学第二医院超声科,甘肃兰州730030 [6]海军军医大学第三附属医院(上海东方肝胆外科医院)超声科,上海201805 [7]中国医科大学附属盛京医院超声科,辽宁沈阳110004 [8]首都医科大学附属北京天坛医院超声科,北京100070 [9]复旦大学附属华山医院超声医学科,上海200032 [10]新疆医科大学第一附属医院腹部超声诊断科,新疆乌鲁木齐830011 [11]西安交通大学第二附属医院医用超声研究室,陕西西安710004 [12]贵州医科大学附属医院超声中心,贵州贵阳550004 [13]吉林大学中日联谊医院超声科,吉林长春130031 [14]成都市第一人民医院超声科,四川成都610000 [15]中国科学技术大学附属第一医院(安徽省立医院)超声医学科,安徽合肥230001 [16]重庆大学附属肿瘤医院超声医学科,重庆400030 [17]吉林大学第一医院腹部超声科,吉林长春130021 [18]哈尔滨医科大学附属肿瘤医院超声科,黑龙江哈尔滨150081

出　　处：《中国医学影像学杂志》2024年第11期1147-1154,共8页Chinese Journal of Medical Imaging

摘　　要：目的 探讨超声造影对胆囊息肉样病变(直径≥10 mm)的鉴别诊断价值。资料与方法 前瞻性纳入2021年12月1日—2024年6月30日17家医院行胆囊切除术的胆囊息肉样病变患者229例,分析患者一般情况、常规超声和超声造影特征与息肉性质的关系,采用多因素Logistic回归筛选肿瘤性息肉的独立危险因素,比较不同指标的鉴别诊断价值。结果 胆固醇性息肉108例,腺瘤102例,息肉型胆囊癌19例。胆固醇性息肉和肿瘤性息肉患者年龄(Z=-4.476,P<0.001)、息肉数量(χ^(2)=15.561,P<0.001)、直径(Z=-8.149,P<0.001)、回声(χ^(2)=9.241,P=0.010)、血流信号(χ^(2)=23.107,P<0.001)、增强强度(χ^(2)=47.610,P<0.001)、增强模式(χ^(2)=6.468,P=0.011)、血管形态(χ^(2)=84.470,P<0.001)、胆囊壁完整性(χ^(2)=7.662,P=0.006)、基底部宽度(Z=-9.831,P<0.001)差异有统计学意义。腺瘤和息肉型胆囊癌患者年龄、息肉部位、直径、回声、增强模式、血管形态、基底部宽度差异有统计学意义(Z=-4.333、-3.902、-5.042,P均<0.05)。Logistic回归分析显示,高增强、分支型血管形态、基底部宽度是肿瘤性息肉的独立危险因素(OR=4.563、5.770、3.075,P均<0.001)。独立危险因素联合鉴别胆固醇性息肉和肿瘤性息肉优于单一指标和息肉直径(P均<0.01)。结论 超声造影可有效鉴别胆囊息肉样病变的性质,为选择治疗方式提供影像学依据。Purpose To explore the value of contrast-enhanced ultrasound(CEUS)in the differential diagnosis of gallbladder polypoid lesions(GPLs)(diameter≥10 mm).Materials and Methods A prospective enrollment of 229 patients with GPLs who underwent cholecystectomy in 17 hospitals from December 12021 to June 302024 was conducted to analyze the relationship between general data,conventional ultrasound,CEUS characteristics and the nature of GPLs.Multivariate Logistic regression was employed to identify independent risk factors for neoplastic polyps,the differential diagnostic value of different indicators was compared.Results Among 229 patients with GPLs,there were 108 cases of cholesterol polyps,102 cases of adenoma and 19 cases of gallbladder cancer.Age(Z=-4.476,P<0.001),polyp number(χ^(2)=15.561,P<0.001),diameter(Z=-8.149,P<0.001),echogenicity(χ^(2)=9.241,P=0.010),vascularity(χ^(2)=23.107,P<0.001),enhancement intensity(χ^(2)=47.610,P<0.001),enhancement pattern(χ^(2)=6.468,P=0.011),vascular type(χ^(2)=84.470,P<0.001),integrity of gallbladder wall(χ^(2)=7.662,P=0.006)and stalk width(Z=-9.831,P<0.001)between cholesterol polyps and neoplastic polyps were statistically significant.Age,location,diameter,echogenicity,enhancement pattern,vascular type and stalk width between adenoma and gallbladder cancer were statistically significant(Z=-4.333,-3.902,-5.042,all P<0.05).Multivariate Logistic regression analysis showed that hyper-enhancement,branched vascular type and stalk width were independent risk factors for neoplastic polyps(OR=4.563,5.770,3.075,all P<0.001).The combination of independent risk factors was better than single factor and diameter in the differential diagnosis of cholesterol polyps and neoplastic polyps(all P<0.01).Conclusion CEUS can effectively identify the nature of GPLs and provide a valuable imaging reference for the selection of treatment methods.

关 键 词：胆囊息肉样病变 腺瘤性息肉 胆固醇息肉 超声检查 超声造影 诊断 鉴别 多中心研究 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575.6[医药卫生—诊断学]