超声造影诊断鳃裂囊肿的价值

Value of contrast-enhanced ultrasonography in the diagnosis of branchial cleft cysts

目的探讨超声造影在诊断鳃裂囊肿中的应用价值。方法收集2006年7月至2011年12月本院13例颈部包块患者，术前常规超声检查拟诊为鳃裂囊肿，且高频超声均未发现囊肿明显瘘管结构。分析患者鳃裂囊肿的发生部位、高频超声表现和囊内液细胞学检查的病理结果。超声引导下于囊腔内注入超声造影剂后，观察患者有无瘘管形成，明确瘘管走行方向及内口位置，并与手术病理结果对照。结果13例患者中，发生于左侧颌面部或侧颈部的8例，右侧5例。高频超声表现I型6例，呈圆形无回声或伴稀疏点状回声；Ⅱ型4例，呈圆形低回声，内部回声密集均匀或不均匀；Ⅲ型3例，呈圆形混合回声，密集低回声内可见点状强回声漂浮伴彗星尾征或附壁低回声隆起。13例囊性肿块中，抽出液体最少约1ml，最多约10ml，病理细胞学检查均排除恶性病变。注入超声造影剂后动态观察，10例可见造影剂仅局限于囊腔内，无瘘管形成；3例囊腔内造影剂经瘘管向颈部深方走行，手术病理证实有鳃裂瘘形成。结论超声造影可显示高频超声不能观察的瘘管走行途径，能为临床制定手术计划提供更详尽的信息。

Objective To evaluate the contrast-enhanced ultrasound （CEUS） for the diagnosis of branchial cleft cysts. Methods Thirteen patients with cervical masses were recruited from Foshan First People＇ Hospital between July 2006 and December 2011. Branchial cleft cyst was indicated by preoperative routine ultrasonography, without signs of fistula structures diagnosed by high-frequency uhrasonography. The location of branchial cleft cysts, manifestations of high-frequency uhrasonography and pathological findings of cystic fluid cytology were analyzed. The contrasting agent was injected into the cystic cavity, guided by uhrasonography, to determine the formation of fistula, and if anty, the direction, contour and the location of entrance of the fistula were assessed, which entailed comparison with pathologic findings following surgery. Results Of the 13 patients, the branchial cleft cysts formed in the left cervical or maxillary side in 8 cases and the right side in 5 cases. High-frequency ultrasound demonstrated 6 cases with type I branchial cleft cysts, which appeared as round-shaped images without echoes or sparsely dotted images with echoes, and 4 cases with type Ⅱ branchial cleft cysts, with hypoechoic round-shaped images that were either internally homogeneous or heterogeneous, as well as 3 cases with type Ⅲ branchial cleft cysts, which demonstrated mixed round-shaped echoes with dotted echogenic floating comet tail signs or mural hypoechoic bulges. Of the 13 cases with cystic mass, 1 ml to 10 ml of the liquid could be extracted, with malignant lesions being unanimously excluded by pathological cytology. Dynamic observations with contrasting agent showed that the contrast agent was visible and confined within the cysts without fistula formation in 10 cases and that the contrasting agent traveled to the distal portion of the fistula in 3 cases, who were subsequently confirmed as having branchial fistula cysts by pathology examinations following surgical procedures. Conclusion Compared with high-frequency uhrasonography, the contrast-enhanced ultrasonography can display the travel of bronchial fistula and may provide more detailed information for surgeries.