胆囊隆起性病变超声造影增强模式的探讨

目的 探讨胆囊隆起性病变超声造影的血流灌注过程及其增强模式,评价其应用价值.方法 对47例胆囊隆起性病变进行彩色多普勒超声和造影超声检查,观察胆囊壁及病变的增强时间和增强模式.结果 经手术病理证实的47例中良性病变35例,恶性病变12例.彩色多普勒超声检出病变内血流信号19例(40%,19/47);超声造影增强病例38例(81%,38/47),P<0.005.胆囊壁平均始增时间为(16.2±1.9)s,良性病变平均始增时间(16.3±2.8)s,恶性病变平均始增时间(16.2±3.2)s,未见明显统计学差异(P=0.92).47例胆囊隆起性病变增强模式分为4类:Ⅰ类:无增强;Ⅱ类:动脉相均匀增强;Ⅲ类:动脉相蜂窝状不均匀增强;Ⅳ类:动脉相血管呈杂乱树枝状高增强.所有良性病变造影模式分别表现为Ⅰ类到Ⅲ类,11例(92%,11/12)恶性病变表现为Ⅳ类,1例表现为Ⅲ类.11例恶性病例动脉相胆囊壁局部连续性显示中断.结论 超声造影可显示胆囊隆起性病变的血流灌注过程.特征性的增强模式,可以提高鉴别诊断能力.动脉相胆囊壁显示是否完整连续对鉴别良恶性有意义.

Contrast-enhanced Ultrasound in Elevated Lesions of Gallbladder

Objective Study on contrast-enhanced ultrasound (CEUS)in elevated lesions of gallbladder.Methods Forty-seven lesions of gallbladder were performed by color Doppler ultrasound (CDUS) and CEUS examinations.The beginning enhancement time of gallbladder wall and enhance pattern of the lesions were recorded.Results There were 35 benign lesions and 12 malign lesions among 47 cases.Blood flow among nineteen (40%,19/47)lesions were detected out by CDFI,but 38(81%,38/47)lesions were enhanced by CEUS(P<0.005).The beginning enhancement time of gallbladder wall,benign lesions,malignant lesions were 16.2±1.9s,16.3±2.8s,16.2±3.2s,respectively(P=0.92).The enhance pattern of the lesions were divided into four types.Type Ⅰ:no enhancement;Type Ⅱ:uniform enhancement;Type Ⅲ:alveolate inequable enhancement;Type Ⅳ:tortuous-branched enhancement.All of the benign lesions were from type Ⅰ to type Ⅲ.Eleven(92%) malignant lesions were type Ⅳ.Eleven malignant lesions showed series intervals in gallbladder wall during arterial phase.Conclusions The CEUS could describe the dynamic blood perfusion of gallbladder lesions.It was useful for differentiating benign from malignity lesions.