肝外胆管癌超声造影的诊断价值

目的观察肝外胆管癌的超声造影特点,探讨该技术对肝外胆管癌诊断及鉴别诊断的价值。方法对21例经手术病理或胆管造影证实的肝外胆管癌患者进行二维及彩色多普勒超声检查,并经静脉团注SonoVue造影剂,行超声造影检查,观察肿块强化开始时间、强化方式、持续时间等,同时采用爆破及造影剂捕捉功能,重复观察病灶内造影剂灌注及显示情况。结果注射造影剂后,肿块9~19s肿块开始显影,所有肿块均有强化,持续时间约10~20s。肿块强化开始时间晚于总胆管壁,消退早于后者。21例患者中有5例伴有结石,5例侵犯周围肝组织,二维超声均难以判断。超声造影可以准确鉴别肿块和结石,并且能够判断肿块的侵犯范围,与手术病理结果一致。结论超声造影能实时观察肝外胆管肿块的微血流灌注情况,对肝外胆管癌的定性诊断及与胆管结石的鉴别诊断有较高的临床应用价值。

Contrast-enhanced Sonography in Diagnosis of Extrahepatic Biliary Tract Carcinomas

Objective To depict the characteristics of extrahepatic biliary tract carcinomas by contrast-enhanced ultrasound and to evaluate the clinical value of this method in the diagnosis and differential diagnosis of extrahepatic biliary tract carcinomas.Methods Totally 21 patients confirmed with extrahepatic biliary tract carcinomas by pathology or cholangiography underwent baseline scan,color Doppler and contrast enhanced ultrasound examination after bolus injection of second generation contrast medium SonoVue.Contrast-enhanced ultrasonographic features such as fill-in time,fill-in pattern and wash-out time were observed.Flash and capture function were also used to depict the re-filling of the contrast medium into the masses.Results All the lesions began to get enhancement 9-19 seconds after the iniection of SonoVue which were later than the enhancement of the common bile duct wall.Enhancement in the masses persisted for 10-20 seconds and wash-out occured earlier than that of the common bile duct wall.Stones were also found in the common bile duct in 5 patients and 5 patients with adjacent liver involvement which were difficult to differentiate by baseline scan.While under contrast-enhanced condition,stones could be easily differentiated from the mass,and the involvement area could also be showed clearly with operational and pathologic accordant results.Conclusions Contrast-enhanced sonography could offer real-time imaging of the fill-in of the microcirculation in extrahepatic biliary tract carcinomas and may contribute to the diagnosis and the differential diagnosis of the disease.