超声双重造影评价胃癌淋巴结转移的应用价值

Application of double contrast-enhanced ultrasonography to access the lymph nodes metastasis of gastric carcinoma

目的 探讨超声双重造影技术在评价胃癌淋巴结转移中的应用价值.方法 经手术病理证实的116例胃癌患者,术前行超声双重造影检查,并对胃癌组织进行超声定量分析,检测基础强度（BI）、峰值强度（PI）、开始增强时间（AT）和达峰时间（TTP）等参数,计算增强强度（EI,EI=PI-BI）和灌注时间（WIT,WIT=TTP-AT）.术后根据病理结果将所有患者分为两组：N1组,淋巴结转移组,69例;N0组,无淋巴结转移组,47例.超声双重造影定量分析结果与手术病理结果对比,并采用Kappa法对该方法的可靠性进行检验.结果 N1组胃癌组织BI值显著低于N0组[（1.41±1.56）dB对（3.92±2.82）dB,t=-4.81,P=0.000],EI值显著高于N0组[（20.67±3.71）dB对（14.12±3.75）dB,t=7.31,P=0.000],而WIT值显著短于N0组[（9.12±2.99）s对（10.88±3.05）s,t=-2.43,P=0.018].绘制ROC曲线,通过计算曲线下面积得知,以胃癌组织EI＞17.05 dB作为胃癌淋巴结转移的诊断标准,其灵敏度为80.50%,特异度为76.70%,且具有较高的重复可靠性（Kappa=0.88）.结论 胃癌组织EI值可间接评价胃癌的淋巴结转移情况.

Objective To investigate the clinical value of double contrast-enhanced ultrasonography （DCUS） in diagnosing lymph nodes metastasis of gastric carcinoma.Methods One hundred and sixteen patients with gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined by DCUS preoperatively.The enhanced characteristic of gastric carcinoma tissues was assessed by autotracking contrast quantification（ACQ） software.The baseline intensity（BI）, peak intensity（PI）, arrival time（AT） and time to peak（TTP） of gastric cancer was measured automatically,and the enhanced intensity （EI） and wash-in time（WIT） of gastric cancer was calculated manually （EI=PI-BI; WIT=TTP-AT）.All of the subjects were divided into two groups according to their lymph nodes status postoperatively：group N1,sixty-nine patients with lymph nodes metastasis; and group N0, forty-seven patients without lymph nodes metastasis.The DCUS quantitative analysis and pathological results of these two groups were compared each other.The Kappa＇s test was used for inter-rater reliability.Results BI of group N1 in the gastric carcinoma tissues was lower than that of group N0 significantly [（1.41 ± 1.56）dB vs （3.92 ± 2.82）dB, t = - 4.81, P = 0.000].EI of group N1 in the gastric carcinoma tissues was higher than that of group N0 significantly [（20.67±3.71）dB vs （14.12±3.75）dB, t=7.31, P=0.000].Moreover, there was a significant difference of WIT in the gastric carcinoma tissues between these two groups[（9.12±2.99）s vs （10.88±3.05）s, t =-2.43, P=0.018].The WIT in patients with lymph nodes metastasis was shorter than that without it. A cut-off value 〉17.05 dB of EI in gastric cancer tissues for assessing the lymph nodes metastasis had a sensitivity of 80.50% and specificity of 76.70% respectively obtained by the area under the ROC curve. The Kappa value of this method was 0.88.Conclusions EI of gastric cancer tissues can be considered as a new potential index to evaluate the lymph nodes metastasis of gastric cancer.