周围型肝内胆管细胞癌:超声造影与增强CT对照

目的 比较周围型肝内胆管细胞癌(ICC)的CEUS与增强CT特点。方法 回顾性分析经手术及病理证实的30例ICC患者(36个病灶)的CEUS及增强CT表现,采用Kappa一致性检验评估两种检查方法诊断的准确率。结果 CEUS显示36个病灶均为动脉期增强,门静脉期及延迟期回声减弱,呈"快进快出"型。增强CT动脉期图像示36个病灶均强化,28个门静脉期及延迟期持续强化,另8个门静脉期及延迟期强化程度减退。CEUS显示19个病灶(19/36,52.78%)周边部环状增强,17个(17/36,47.22%)整体增强;21个(21/36,58.33%)表现为"树枝样"向内延伸。增强CT显示22个病灶(22/36,61.11%)周边环状强化,其中5个呈分隔样强化;14个(14/36,38.89%)为整体强化。达峰值时,CEUS示23个病灶不均匀增强,13个均匀增强;增强CT示20个病灶不均匀增强,16个均匀增强。以"快进快出"、环状增强和(或)"树枝样"增强作为CEUS诊断ICC的标准,CEUS的诊断准确率为70.00%(21/30);以动脉期"环状强化",门静脉期及延迟期"持续强化"作为CT诊断ICC的标准,增强CT的诊断准确率为73.33%(22/30);Kappa一致性检验显示两种检查方法具有很好的一致性(Kappa值＝0.824)。结论 周围型ICC的CEUS与增强CT表现具有一定特征性;两种方法对于周围型ICC均有较高诊断价值。

Comparison of enhancement features of peripheral intrahepatic cholangiocarcinoma on contrast-enhanced ultrasound and dynamic enhanced CT

Objective To analyze and compare features of peripheral intrahepatic cholangiocarcinoma (ICC) in CEUS and dynamic enhanced CT. Methods Thirty patients with ICC (36 lesions) confirmed by pathology were analyzed retrospectively, and the CEUS characteristics were compared with those of dynamic CT. Results Thirty-six lesions manifested hyper-enhancement in arterial phase and displayed hypoecho in the portal and delayed phase on CEUS. All lesions displayed "fast-in and fast-out" enchancement pattern. On dynamic CT, all lesions present the same characteristics as CEUS in the arterial phase, 28 lesions showed hyper-enhancement continuously, and the rest hypo-enhanced in the portal and delayed phase. On CEUS, 19 lesions (19/36, 52.78%) displayed rim-like enhancement, 17 (17/36, 47.22%) displayed gross enhancement. During the process of enhancement, the pattern of branch-like from peripheral to inside was observed in 21 lesions (21/36, 58.33%). On dynamic CT, 22 lesions (22/36, 61.11%) showed rim-like enhancement, 5 of them describing separate enhancement and 14 (14/36, 38.89%) showed gross enhancement. At the peak intensity, 23 lesions were inhomogeneous and 13 were homogeneous on CEUS, whereas 20 were inhomogeneous and 16 were homogeneous on dynamic CT. The accuracy of CEUS was 70.00% (21/30) according to the standard of "fast-in and fast-out", rim-like and/or branch-like enhancement during the arterial phase. The accuracy of dynamic CT was 73.33% (22/30) according to "rim-like enhancement" in the arterial phase and hyper-enhancement continuously. The diagnostic accuracy of these two methods appeared good consistency (Kappa value is 0.824). Conclusion ICC has some characteristics in CEUS and dynamic CT, both of them have high diagnostic value.