超声造影在提高隆突性皮肤纤维肉瘤手术精度中的价值

Value of contrast-enhanced ultrasound in improving surgical precision for dermatofibrosarcoma protuberans

目的探讨超声造影(CEUS)在提高隆突性皮肤纤维肉瘤(DFSP)手术精度中的价值。方法通过对我院皮肤科收治的23例经病理证实为DFSP的CEUS图像进行回顾性分析,总结其灌注特征;术前利用传统超声和CEUS评估每一肿瘤的手术切缘,测量大小(长×宽×厚,cm),将传统超声与术后病理测量的差值和CEUS与病理测量的差值进行比较分析,评价CEUS对提高DFSP手术切缘精度的价值。结果 23例DFSP与周围正常皮下组织的增强时间对照,造影剂整体呈快进慢退型。其中17例为快进弥漫性均匀性高增强; 4例为快进弥漫性非均匀性高增强,内部伴充盈缺损; 2例为快进均匀性等增强。增强后肿瘤边界清晰,范围均增大。传统超声和CEUS测量肿瘤的长、宽、厚值与病理测量的差值比较差异具有统计学意义(均P <0. 05),CEUS与病理的测量差距更接近。结论 CEUS可显示DFSP内部及周缘的微循环,清晰显示造影后肿瘤扩大的边缘,对提高DFSP手术精度具有显著价值。

Objective investigate the value of contrast-enhanced ultrasound improving the surgical precision for dermatofibrosareoma protuberans (DFSP).Methods (CEUS )in Twenty-three patients with pathologically confirmed DFSP (23 lesions)were enrolled in this study.Before surgical resection of DFSP,the patients received examinations with conventional ultrasound and CEUS to evaluate the perfusion features of the lesions,surgical margins,and tumor dimensions;The differences between the measurements based on the 2 ultrasound modalities and postoperative pathological measurements were analyzed.Results In all the 23 cases,DFSP showed enhanced perfusion earlier than the surrounding subcutaneous tissue,and the contrast agent was washed out slowly.Seventeen patients presented with rapid contrast agent filling with high and homogeneous perfusion in the tumor compared with the surrounding normal skin;4 patients showed rapid contrast agent filling and high and inhomogeneous perfusion with filling defects;2 patients showed isoenhancement with rapid contrast agent filling.In CEUS,DFSP lesions showed clear and enlarged tumor margins.The tumor dimensions measured by traditional ultrasound and CEUS were significantly different from those by pathological measurements (P <0.05),but the measurements by CEUS were closer to the pathological measurements.Conclusion CEUS can show the internal and peripheral microcirculation of DFSP and clearly displays the enlarged tumor margins after contrast enhancement to improve the precision of surgical resection.