超声造影在胆囊息肉样病变鉴别诊断中的应用价值

The value of contrast-enhanced ultrasound in the differential diagnosis of polypoid lesions of gallbladder

目的比较各种类型胆囊息肉样病变超声造影表现,探讨超声造影在胆囊息肉样病变鉴别诊断中的应用价值。方法回顾性分析2007年5月至2012年11月上海市第十人民医院经手术病理证实的112例胆囊息肉样病变患者超声造影表现,包括胆囊癌18例、胆囊腺瘤20例、胆囊胆固醇性息肉及炎性息肉63例、胆囊腺肌增生症6例、胆泥5例。记录各种类型胆囊息肉样病变病灶大小、病灶增强时间、增强水平、血管形态、病变邻近胆囊壁层次结构的完整性及病变的基底部特征。各病变病灶直径、超声造影增强时间比较应用单因素方差分析,进一步组间两两比较应用LSD-t检验。结果胆囊癌病灶直径大于其他各病变,且差异均有统计学意义(t值分别为1.474、8.553、3.984、1.362、3.488,P均<0.05)。胆囊癌、胆囊腺瘤、胆囊胆固醇性及胆囊炎性息肉、胆囊腺肌增生症超声造影多表现为早期高增强及晚期低增强模式,而胆泥超声造影增强早期及晚期均表现为无增强。胆囊癌开始增强时间均晚于胆囊腺瘤及胆固醇性息肉,且差异均有统计学意义(t值分别为2.321、2.219,P均<0.05),其余各病变开始增强时间差异无统计学意义;胆囊癌组达峰时间均晚于其他各病变,且差异均有统计学意义(t值分别为3.562、4.588、2.004、12.361,P均<0.05);胆囊癌、胆囊腺瘤增强变等时间均晚于胆固醇性息肉,且差异均有统计学意义(t值分别为5.407、2.924,P均<0.05);胆囊腺瘤增强变低时间均晚于其他各病变,且差异均有统计学意义(t值分别为3.109、6.342、1.811、6.012,P均<0.05)。与胆囊良性息肉样病变比较,胆囊癌患者均为宽基底,胆囊壁结构不完整,层次不清晰。结论超声造影是胆囊息肉样病变常规超声检查的重要补充,综合分析其增强模式、增强时间及胆囊壁形态学改变指标有助于胆囊癌与胆囊良性息肉样病变的鉴别诊断。

Objective To investigate the value of contrast-enhanced ultrasound in the differential diagnosis of polypoid lesions of gallbladder. Methods Contrast-enhanced ultrasound data from 112 patients with polypoid lesions of gallbladder （18 patients with gallbladder carcinoma, 20 patients with gallbladder adenomas, 63 patients with cholesterol polyps and inflammatory polyps, 5 patients with biliary sludge and 6 patients with adenomyomatosis of gallbladder） were retrospectively analyzed, including the initial enhancement time, enhancement level, enhanced vascular morphology, integrality of gallbladder wall adjacent to lesions and characteristics of basement of lesions. All lesions were confirmed by pathology. Results The lesions were bigger in patients with gallbladder carcinoma than those in other groups （t=-1.474, 8.553, 3.984, 1.362, 3.488, all P 〈 0.05）. Patients with biliary sludge showed no enhancement, while most of patients with other lesions showed hyper-enhancement during initial period and hypo-enhancement during late period. The time to initial enhancement was significantly shorter in patients with gallbladder carcinoma than that in patients with gallbladder adenomas and cholesterol polyps （t=-2.321, 2.219, both P 〈 0.05）. The time to peak enhancement was significantly shorter in patients with gallbladder carcinoma than that in patients with other lesions （t=-3.562, 4.588, 2.004, 12.361, all P 〈 0.05）. The time to iso-enhancement in patients with cholesterol polyps was significantly shorter than that in patients with gallbladder carcinoma and gallbladder adenomas （t=-5.407, 2.924, both P 〈 0.05）. The time to hypo-enhancement in patients with gallbladder adenomas was significantly longer than that in other groups （t=-3.109, 6.342, 1.811, 6.012, all P 〈 0.05）. When compared with other groups, the width of basement increased and the integrality of gallbladder wall destructed in patients with gallbladder carcinoma. Conclusions CEUS is an important supplement for the routine ultrasonography of polypoid lesions of gallbladder. A comprehensive analysis of gallbladder enhancement model, enhancement time and morphological changes of gallbladder wall is useful in the differential diagnosis of polypoid lesions of gallbladder.