胆管内乳头状肿瘤超声及超声造影表现

摘要

目的 探讨胆管内乳头状肿瘤(intraductal papillary neoplasm of bile duct,IPN-B)的常规超声及超声造影表现.方法 回顾性分析8例经病理确诊的IPN B患者共9个病灶的常规超声和超声造影表现.超声造影采用SonoVue造影剂和低机械指数连续实时成像技术.结果 常规超声5个病灶表现为“胆道扩张型”,即胆管内有乳头状肿物4例、菜花状肿物1例,均有肝内外胆管不同程度扩张,血供稀少；3个病灶表现为“囊实混合型”肿物,实性病灶内可见多个小片状无回声区,病灶均与周围轻度扩张胆管相通,血供丰富或稀少；超声造影8个病灶实性成分具有动脉期均匀或不均匀高增强,门脉期、延迟期减退为低增强的特点,1个病灶超声及超声造影未见明确肿瘤性病变.结论 胆管内乳头状肿瘤超声及超声造影检查术前诊断率低,需进一步提高对该病的认识,常规超声发现扩张的胆管内有乳头状结节或菜花状肿物,超声造影提示动脉期呈高增强,门脉期、延迟期减退为低增强,需考虑胆管内乳头状肿瘤的诊断.%Objective To investigate the features of intraductal papillary neoplasm of the bile duct (IPN-B) on baseline ultrasound and contrast-enhanced ultrasound (CEUS).Methods A retrospective analysis of the baseline ultrasound and CEUS in nine pathologically proven IPN-B lesions in eight patients.CEUS was performed with low mechanical index and continuous real-time imaging technique and the contrast agent of SonoVue.Results On conventional ultrasound,5 lesions were appeared as "expansion of bile duct type",whose main features were cauliflower shape tumor (n =1) or papillary nodes (n =3) in expanded bile duct with rare blood supply;the other 3 lesions were appeared as "complex cystic type",which contained cystic and solid components in the lesions.Many tiny anechoic areas were observed inside the solid lesions.Two lesions were rich in blood supply and another one was rare.All were communicated with adjacent slightly dilated bile duct.On CEUS,solid components of eight lesions appeared homogeneous (n =5) or heterogeneous (n =3) hyper-enhancement in the arterial phase and declined into hypo-enhancement in the portal and late phases.One lesion,on the contrary,was invisible on both conventional ultrasound and CEUS.Conclusions Understanding the ultrasound features of IPN-B is mandatory because of its low preoperative diagnosis rate on CEUS.IPN-B should be taken into consideration when cauliflower shape tumors or papillary nodules in expanded bile duct,as well as hyper-enhancement in the arterial phase and hypo-enhancement in the portal and late phases on CEUS,were demonstrated.