超声造影对原发性胆囊癌诊断的应用价值探讨

Application value of contrast-enhanced ultrasonography in the diagnosis of gallbladder carcinoma

目的：探讨超声造影（CEUS）在原发性胆囊癌诊断中的应用价值。方法：回顾性分析经手术和病理确诊的46例原发性胆囊癌患者的CEUS图像特征以及同Nevin分期的关系。结果：37病例CEUS检查可见造影增强,病灶较常规超声显示更清晰。病灶与胆囊壁同时显影,开始显影时间为5-16 s,增强达峰值时间为14-30 s,病灶增强达峰值强度均高于自身正常胆囊壁,开始消退时间为20~55 s。胆囊癌肝转移灶表现为动脉期边缘快速环状增强,内部稀疏增强,门脉期快速消退,呈＂黑洞征＂。在造影后发现更多的转移灶。CEUS对原发性胆囊癌诊断符合率明显高于彩色多普勒血流显像（73.9%vs 50.0%,P〈0.05）;然而具体至Nevin分期,两种方法差异无统计学意义。结论：CEUS对原发性胆囊癌的诊断具有重要的价值,而对于其早期病例仍须进一步研究。

Objective： To explore the application value of contrast-enhanced ultrasonography（CEUS） in the diagnosis of gallbladder carcinoma. Methods： The images characteristics of CEUS of 46 cases with gallbladder carcinoma proved by surgery and pathological diagnosis and the relationship with Nevin stage were retrospectively reviewed. Results： The CEUS examination of 37 cases with gallbladder carcinoma showed contrast-enhanced images,which were more clearly than conventional ultrasound. The developing time was 5- 16 s,which was the same as that of gallbladder wall. The peak time was 14- 30 s,and the peak intensity was higher than that of normal gallbladder wall. The fade time was 20- 55 s. Hepatic metastasis of gallbladder carcinoma showed rapid ring-enhanced arterial phase,the internal sparse enhanced and portal phase quickly faded,as a＂black hole sign＂.More metastatic lesions were revealed during the contrast CEUS. The diagnostic accuracy of primary gallbladder carcinoma of CEUS was significantly higher than that of color Doppler flow imaging（73. 9% vs 50. 0%,P 〈 0. 05）.While specific to each Nevin staging,there was no significant difference between two methods. Conclusions：CEUS has an important reference value in the diagnosis of primary gallbladder carcinoma and further research is necessary for the cases in early stage.