超声造影新技术对胆囊良恶性疾病的鉴别诊断价值

目的 探讨超声造影对胆囊疾病良恶性鉴别诊断的临床应用价值.方法 采用低机械指数实时超声造影技术检查80例常规超声疑为胆囊占位的病例,包括胆囊癌33例和良性病变47例.分析胆囊病变的增强时间、增强模式以及病变部位胆囊壁层次结构的完整性,评估超声造影鉴别胆囊病变良恶性的诊断性能.结果 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96.8%(30/31)、良性病变中占19.5%(8/41)(P<0.001).CEUS增强早期病变呈高增强或等增强变为低增强平均时间胆囊癌为(29.5±9.8)s、良性病变为(58.8±13.9)s(P<0.001).病变表现为不均匀增强者在胆囊癌中占78.8%(26/33),良性病变中占27.6%(13/47)(P<0.001).病变处胆囊壁完整性破坏者在胆囊癌中占84.8%(28/33),良性病变中占0.0%(0/47)(P<0.001).常规超声检查胆囊疾病诊断正确率为72.5%(58/80),超声造影检查胆囊病变诊断正确率为93.8%(75/80)(P<0.001).结论 超声造影较普通超声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.

Value of contrast-enhanced ultrasound for differentiation between benign and malignant gallbladder diseases

Objective To investigate the clinical value of contrast-enhanced ultrasound in differ-entiation between benign and malignant gallbladder diseases. Methods Contrast-enhanced ultrasound was performed in eighty patients who were suspicious of gallbladder cancer by conventional ultra-sound. Final diagnosis proved that it was gallbladder cancers 33 patients and benign gallbladder disease in 47. Contrast agent SonoVue and low mechanical index imaging mode were applied. The contrast en-hancement characteristics of the initial enhancement time, the enhancement pattern and the integrality of gallbladder wall adjacent to lesions were analyzed. Meanwhile, the ability of differentiating diagno-sis between benign and malignant gallbladder diseases with contrast-enhanced ultrasound was investi-gated. Results The percentages of those lesions that exhibited hyper-enhancement or iso-enhancement in the early phase and turned to hypo-enhancement within 35s after contrast agent administration were 96.8 % (30/31) in gallbladder cancers and 19.5 % (8/41) in benign lesions(P<0. 001), and the mean time to be hypo-enhancement was (29.5 ± 9.8) s in gallbladder cancers and (58. 8±13.9) s in benign lesions (P<0. 001). Inhomogeneous enhancement was found in 26 (78. 8% ,26/33) gallbladder carci-nomas and 13 (27.6% ,13/47) benign lesions (P<0. 001). Destruction of the integrality of gallblad-der wall was found in 28 (84. 8% ,28/33) gallbladder carcinomas and none (0. 0% ,0/47) of benign le-sions (P<0. 001). The accuracies for differential diagnosis between malignant and benign gallbladder diseases were 72. 5% (58/80) for conventional ultrasound and 93. 8% (75/80) for contrast-enhanced ultrasound (P<0. 001). Conclusion Contrast-enhanced ultrasound can significantly improve the abili-ty of differentiating diagnosis between benign and malignant gallbladder diseases compared with con-ventional ultrasound. The method is deserved to be popularized in clinical practice.