超声造影模式在胆囊癌诊断中的应用价值

摘要

目的 探讨实时超声造影(CEUS)增强模式对胆囊癌的鉴别诊断价值.方法 20例胆囊癌和37例胆囊良性病变患者行常规超声及CEUS检查,重点观察病灶的造影增强模式.结果 胆囊癌CEUS表现为病灶与胆囊壁同时显影,肝动脉期以增强明显为主,肝门静脉期以低增强为主.在CEUS增强早期呈高增强或等增强并在造影剂注射后35 s内变低增强者在胆囊癌中占95.0％(19/20)；良性病变中占16.2％(6/37) (P =0.000).病变表现为不均匀增强者在胆囊癌中占80.0％ (16/20),良性病变中占23.3％ (7/30)(P =0.000).病变处胆囊壁完整性破坏者在胆囊癌中占85.0％ (17/20),良性病变中占0.0％ (0/37) (P=0.000).超声检查诊断胆囊良恶性病灶的准确性92.98％、敏感性95.00％和特异性91.83％.结论 CEUS可提高超声诊断胆囊癌的准确率,能显著改善对胆囊疾病良恶性鉴别诊断能力,值得临床应用推广.%Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS) in the diagnosis of gallbladder cancer.Methods Twenty patients with gallbladder cancer and thirty-seven patients with benign gallbladder disease underwent conventional ultrasound and real-time CEUS.The enhancement patterns including types of time-intensity curve,centripetal fill-in,homogeneity and intensity of enhancement were analyzed.Results The focus and gallbladder wall in gallbladder cancers were enhanced at the same time,hepatic artery phase was mainly highly enhanced,hepatic portal vein phase was mairdy lowly enhanced.The percentages of those lesions that exhibited hyper-enhancement or iso-enhancement in the early phase and turned to hypo-enhancement within 35 s after contrast agent administration were 95.0％ (19/20) in gallbladder cancers and 16.2％ (6/37) in benign lesions(P =0.000).Inhomogeneous enhancement was found 80.0％ (16/20) in gallbladder cancers and 23.3％ (7/30) in benign lesions (P =0.000).Destruction of the integrality of gallbladder wall was found 85.0％ (17/20) in gallbladder cancers and none (0.0％,0/37) in benign lesions (P =0.000).The diagnose accordance rate、sensitivity and specificity of benign and malignant gallbladder diseases by CEUS was were 92.98％ 、95.00％ and91.83％,respectively.Conclusion CEUS can improve the diagnosis rates of gallbladder cancer and the ability of differentiating diagnosis between benign and malignant gallbladder diseases compared with conventional ultrasound.