超声造影对肝门部胆管癌的诊断价值

Value of contrast-enhanced ultrasound in the diagnosis of hilar cholangiocarcinoma

目的探讨超声造影在肝门部胆管癌术前评估中的临床应用价值。方法回顾性分析2005年1月至2010年12月在中山大学附属第三医院行超声检查怀疑肝门部胆管癌，进一步行超声造影，最终得到计算机体层摄影术（CT）或磁共振成像（MRI）确诊的72例患者临床资料。其中男60例，女12例；年龄18-90岁，中位年龄65岁。患者均签署知情同意书，符合医学伦理学规定。所有患者分别采用常规超声和超声造影检查行腹部扫描，超声造影检查应用六氟化硫微泡为造影剂，采用低机械指数造影特异性成像技术。观察两种方法对肝门部胆管癌肿瘤显示和分型诊断的情况，采用CT或MRI结果作为诊断金标准，计算其对肿瘤显示和分型诊断的灵敏度。两种方法的灵敏度比较采用，榆验。结果常规超声检查显示47例肿瘤表现为低回声或高回声软组织肿块，25例等回声不能清楚显示。超声造影动脉期肿瘤显示呈高增强者占50％（36／72）、等增强者22％（16／72）例、低增强者占28％（20／72），72例患者静脉期肿瘤显示均表现为低增强，可以清楚显示肿瘤浸润范围。超声造影对肝门部胆管癌显示的灵敏度为1．00（72／72），常规超声检查为0．65（47／72），超声造影对肝门部胆管癌的灵敏度明显优于常规超声检查（矿=19．615，P〈0．05）。超声造影对肝门部胆管癌分型诊断的灵敏度为0．92（66／72），常规超声检查为0．83（60／72），两种方法比较差异无统计学意义（矿：2．286，P=0．131）。结论相对于常规超声检查，超声造影能较好地显示肿瘤的实际浸润范围，提高了对肝门部胆管癌显示的灵敏度，分型诊断的灵敏度较高，能准确地对肝门部肿瘤进行术前评估。

[Abstract] Objective To investigate the clinical value of contrast-enhanced ultrasound （CEUS） in the preoperative evaluation of hilar cholangiocarcinoma. Methods The objects of this retrospective study were 72 patients who were suspected with hilar cholangiocarcinoma by conventional ultrasound, then underwent CEUS and hilar cholangiocarcinoma was finally confirmed by computed tomography （CT） or magnetic resonance imaging （MRI） in the Third Affiliated Hospital of Sun Yat-sen University from January 2005 to December 2010. There were 60 males and 12 females with age ranging from 18 to 90 years old and a median age of 65 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Abdomen scanning was performed on all the patients using conventional ultrasound and CEUS. The contrast medium sulfur hexafluoride microbubbles and the low mechanical index contrast-specific imaging technique were applied. The visualization and diagnosis of classification of hilar cholangiocarcinoma by conventional ultrasound and CEUS were observed. The CT or MRI result was taken as golden standard for diagnosis. The sensitivity of visualization of tumors and diagnosis of classification by two methods were calculated. Chi-square test was used to compare the sensitivity between conventional ultrasound and CEUS. Results For the conventional ultrasound, tumors of 47 cases were visualized as hypo-echoic or hyper-echoic soft tissues mass, while 25 cases were visualized as iso-echonic and unclearly. In the arterial phase of CEUS, the hyper-enhancement was observed in 50% （36/72） patients and the iso-enhancement was observed in 22% （16/72） patients and hypo-enhancement was observed in 28% （20/72） patients. While in the venous phase, hypo-enhancement was observed in all the 72 patients and the infiltration region of tumors were clearly displayed. The visual sensitivity of hilar cholangiocarcinoma by CEUS were 1.00 （72/72）, while 0.65 （47/72） by the conventional ultrasound. CEUS was superior to the conventional ultrasound （X2=19.615, P〈0.05）. The sensitivity of diagnosis of classification was 0.92 （66/72） by CEUS, but was 0.83 （60/72） by the conventional ultrasound. No statistically significant difference was observed （Xz=2.286, P=O.131）. Conclusions Compared with the conventional ultrasound, CEUS could better display the actual infiltration region of tumors, improve the visual sensitivity for hilar cholangiocarcinonm. The sensitivity of diagnosis of classification by CEUS are comparatively higher and can play a certain role in the preoperative evaluation of hilar cholangiocarinoma.