超声造影诊断低分化胆管细胞癌

Contrast enhanced ultrasound diagnosis of poor differentiated cholangiocarcinoma

目的探讨低分化胆管细胞癌的超声造影特征及其应用价值。方法回顾性分析11例病理证实的低分化胆管细胞癌的常规超声图像及造影表现,观察病灶大小、边界、形态、回声、血流分布及分析超声造影各时相的特征。结果二维声像图上病灶多表现为形态不规则(100%),边界模糊(9/11,81.82%),内部低回声(6/11,54.55%);彩色多普勒病灶内部为0级血流信号,周边显示1级血流信号,频谱多普勒示7例(63.64%)病灶阻力指数(RI)≥0.6;超声造影显示11例病灶均于动脉相呈周边环状高增强,内部无造影剂灌注,实质相病灶周边呈环状低增强,但回声高于内部无造影剂灌注部分。结论低分化胆管细胞癌的超声造影增强方式具有一定的特征,超声造影结合二维及彩色多普勒超声可提高对病灶的诊断率。

Objective To investigate the value of contrast enhanced ultrasound（CEUS）in diagnosing poor differentiated cholangiocarcinoma.Methods Sonograms of 11 patients with pathologically confirmed poor differentiated cholangiocarcinoma were retrospectively analyzed.The size,boundary,shape,echo,blood distribution and characteristics of the enhancement duration were observed.Results All lesions presented irregular shape（100%）,most（9/11,81.82%）with indefinite boundary,some（6/11,54.55%）with low echo.No blood flow signal was found in the interior of masses,while grade 1 blood flow signal was detected in periphery of the lesions.Resistance index（RI）was ≥0.6 in spectral Doppler in 7（63.64%）lesions.Marginal rim-like hyperechoic enhancement in the arterial phase was found without centripetal filling in all 11 patients,marginal rim-like hypoechoic enhancement was observed,but being hyperecho compared with interior part without medium in delayed phase.Conclusion The contrast-enhancement modality of poor differentiated cholangiocarcinoma is characteristic.Combined with two-dimensional ultrasonography and color Doppler ultrasound,the diagnostic rate will be improved.