超声造影与增强CT对胆囊病变鉴别诊断的对比研究

Comparison of enhancement pattern and differential diagnosis efficacy between contrast-enhanced ultrasound and contrast-enhanced computed tomography for gallbladder diseases

目的探讨胆囊良恶性病变超声造影（CEUS）和增强CT（CECT）表现特征。方法对经手术病理证实的72例胆囊病变患者的术前CEUS和CECT的增强模式和诊断结果进行比较研究。结果①良性病变CEUS和CECT增强早期大部分均呈高增强，分别为84．6％（33／39）和79．5％（31／39）（P。0．500）。恶性病变CEUS和CECT在增强早期亦以高增强为主，分别有97．0％（32／33）和87．9％（29／33）（P=0．250）。良性增强病变晚期CEUS和CECT上呈低增强者分别为91．2％（31／34）和88．2％（30／34）（P=1．000）。恶性病变在CEUS和CECT上增强晚期均消退为低增强者均为100％。②良性和恶性病变CEUS增强减退为低增强的时间分别为（39．9±15．7）S和（29．9±5．6）s（t=3．61，P=0．000）。③良性病变CEUS和CECT病灶呈不均匀增强者分别为41．0％（16／39）和53．8％（21／39）（P=0．063），恶性病变分别为84．8％（28／33）和97．0％（32／33）（P=0．125）。④恶性病变中CEUS和CECT诊断胆囊壁完整性破坏者分别为87．9％（29／33）和90．9％（30／33）（P=1．000）。⑤CEUS和CECT的良恶性诊断准确率分别为91．7％（66／72）和87．5％（63／72），敏感性为97．0％（32／33）和93．9％（31／33），特异性为87．2％（34／39）和82．15％（32／39）（P值分别为0．250、1．000、0．500）。结论良恶性胆囊疾病在CEUS和CEcT增强模式有相当的一致性，两者诊断效能接近。

Objective To compare the enhancement characteristic of the gallbladder diseases and to evaluate the diagnostic efficacy in differential diagnosis of the gallbladder diseases between contrast-enhanced sonography （CEUS） and contrasvenhanced computed tomography （CECT）. Methods Seventy-two patiens with gallbladder lesions were examined by CEUS and CECT before operation and all final diagnoses were confirmed by surgery and/or pathological diagnosis. Results 1）In early phase,84.6% （33/39） and 79.50% （31/39） of benign diseases showed hyper enhancement on CEUS and CECT, and 97.0K （32/33） and 87.9）% （29/33） of malignant diseases showed hyper-enhancement on CEUS and CECT respectively （ P = 0. 250）. In later phase,91.2% （31/34） and 88.2%（30/34） of benign diseases showing hypo-enhancement （P = 1.000）, and 100% of the malignant diseases showing hypo-enhancement on CEUS and CECT respectively. 2）The time of enhancement from hyper- to hypo in CEUS for benign and malignant diseases were （39.9± 15.7）s and （29.9 ± 5.6）s respeetively （t = 3.61, P = 1.000）. 3）The inhomogeneous enhancement on CEUS and CECT were 41.0% （16/39） and 53.80/00 （21/39） in the benign diseases respectively （ P = 0. 063）,84.8%（28/33） and 97.0%（32/33） in the malignant diseases respectively（ P ： 0. 125）. 4）The destruction of the gallbladder wall on CEUS and CECT are 87.90//00 （29/33） and 90.90/oo （30/33） respeetivdy（ P = l. 000）. 5）The accuracy, diagnostic sensitivity, specificity of CEUS and CECTwere 91.7%（66/72） and 87.5%（63/72 ） ,97.0%（32/33） and 93.9%（31/33）,87.2%（34/39） and 82.15% （32/39） respectively （ P = 0. 250,1. 000,0. 500）. Conclusions The enhancement pattern of the gallbladder diseases on CEUS and CECT were much similar. CEUS has equal diagnostic efficacy in comparison with CECT, but CEUS can supply more diagnostic information than CECT.