目的 探讨超声造影(CEUS)对肝移植后缺血性胆道病变(ITBL)的定性诊断价值,并初步分析CEUS表现与其预后的关系.方法 对36例肝移植患者,连续追踪6～59个月,记录其最终诊断及临床结局.24例确诊为ITBL,3例胆管吻合口狭窄,4例急性排异,4例胆道感染,1例胆泥.所有患者确诊前均接受肝门部胆管壁CEUS检查,由2名医师共同盲法分析,以胆管壁动脉期无或低增强为标准诊断ITBL,计算阅片者的诊断效能及阅片者间的一致性.结果 两位阅片者的诊断敏感性分别为66.7％、62.5％,特异性分别为83.3％、83.3％,准确性分别为72.2％、69.4％,阳性预测值分别为88.9％、88.2％,阴性预测值分别为55.6％、52.6％.阅片者之间的一致性很好(κ=0.83).24例ITBL患者中动脉期胆管壁无增强者发生死亡或二次移植的比率(54.5％)明显高于低增强(20％)、高或等增强者(12.5％).结论 CEUS对ITBL有定性诊断价值,当CEUS显示肝门部胆管壁无增强时提示预后不良,这或许可以成为二次肝移植的指征之一.%Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing ischemic-type biliary lesion (ITBL) and analyze the relation between the enhancement patterns of bile duct wall of ITBL and its outcome.Methods 36 patients confirmed with ITBL (24 cases),anastomotic biliary stricture (3 cases),cholangitis (4 cases),biliarysludge (1 cases),and acute rejection (4 cases),who underwent CEUS examination,were enrolled in this study.The images were retrospectively analyzed in consensus by 2 readers.After reviewing the images,the readers were asked to make a diagnosis of ITBL.The diagnostic standard was hypo-or non-enhancement of hilar bile duct wall in arterial phase on CEUS.Results The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 66.7％,83.3％,72.2％,88.9％,and 55.6％ for reader 1;62.5％,83.3％,69.4％,88.2％,and 52.6 ％ for reader 2,respectively.The interobserver agreement was good (κ =0.83).In 24 ITBL patients,the ratio of mortality or retransplantation with non enhancing hilar bile duct wall in arterial phase was much higher than that with enhancing hilar bile duct wall (non-enhancement 54.5％,hypo-enhancement 20％,hyper-or iso-enhancement 12.5％).Conclusions CEUS had diagnostic value of ITBL.Non-enhancing hilar bile duct wall in arterial phase on CEUS predicated the poor outcome.
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