术中胆道超声造影评价肝移植供体胆管解剖结构:二维与三维超声显像的比较

Comparison of intraoperative contrast enhanced ultrasonic cholangiography in adult living liver donors:between three and two dimensional-imaging

目的比较二维和三维胆道超声造影技术评价活体肝移植胆道解剖结构的差异。方法对13例活体肝移植供体分别行二维及三维胆道超声造影检查,分别对图像质量、可分辨胆管分支的级别及不同级别分支的数目及胆管变异进行评估。两位医师盲法独立对二维及三维超声胆道造影图像进行评价,一致性分析用Kappa检验。结果二维与三维超声胆道造影的图像质量评分显示胆管级别和胆管分支总数目无统计学差异,但二维胆道造影在显示第5、6级末梢胆管分支数目上优于三维胆道造影。两位医师对不同级别胆管分支数目的一致性检验,三维图像评价之间的κ值为0.82;高于二维图像相应κ值0.51。13例中三维超声胆道造影显示3例存在胆道变异,而二维超声造影未能发现。结论三维胆道超声造影较二维超声造影评估胆道变异更准确,而二维胆道超声造影显示末梢小胆管优于三维胆道超声造影检查。

Objective To compare the difference of three-（3D） and two-dimensional （2D） intraoperative contrast-enhanced ultrasonic cholangiography （CEUSC） in adult living liver donors. Methods Thirteen adult of living liver donors had 3D and 2D CEUSC, respectively. Imaging quality, the visualization of branching orders and numbers, and the detection of biliary variation were estimated by two investigators independently. The inter-observer agreement was analyzed by Kappa test. Results There were no statistical difference between 3D CEUSC and 2D CEUSC in comparison of the imaging quality or the visualization of branching orders, respectively （P=0.12,P=0.08）. However, the visualizations of the fifth-and sixth-order of biliary branches in 2D CEUSC images were better than those in 3D CEUSC images （P=0.01）. The inter-observer agreement of the visualization of branching orders in 3D CEUSC images （κ=0.82） was higher than 2D CEUSC images （κ=0.51,P=0.001）. Three cases with biliary anatomical variation in these 13 donors were all detected by 3D CEUSC, but not in 2D CEUSC. Conclusion The 3D CEUSC is a more accurate tool during the evaluation of biliary anatomical variation, while 2D CEUSC is better to discriminate ending biliary branches.