经直肠彩超结合超声造影对直肠间质瘤的诊断价值

Diagnostic Value of Combining Transrectal Ultrasound with Contrast-Enhanced Ultrasound in Rectal Stromal Tumor

目的应用经直肠彩超结合超声造影技术观察直肠间质瘤,探讨直肠间质瘤的超声特征及谐波超声造影技术在直肠间质瘤诊断中的应用价值。方法采用经直肠彩超观察直肠间质瘤病变,再以反向脉冲谐波显像技术对病变行超声造影检查,分析直肠间质瘤的造影灌注特征。结果本组9例直肠间质瘤,其中低度危险程度间质瘤3例,中度危险程度间质瘤1例,高度危险程度间质瘤5例。直肠间质瘤彩色多普勒超声表现为直肠肌层内向腔内或腔外突起的圆形或椭圆形低回声团块,较大肿瘤内部回声多杂乱不均,可见片状无回声区及散在钙化灶,边界较清晰,肿块不直接沿胃肠道壁浸润蔓延,以外生性膨胀性生长为主,邻近肠壁无明显增厚征象,均未探及肠周淋巴结转移。超声造影表现为快速显著增强,对于较大肿瘤,病灶呈不均匀增强,病灶中心坏死区始终无增强。结论经直肠彩超结合超声造影技术能够很好的显示直肠间质瘤的形态范围及微血管灌注情况,对于直肠间质瘤术前明确诊断及病变侵犯肠壁层次分析有指导意义。

Objective Through combining transrectal ultrasound with contrast-enhanced ultrasound, observe the rectal stromal tumor, investigate the ultrasonic features of rectal stromal tumor and reveal the application value of contrast-enhanced harmonic ultrasound in the diagnosis of rectal stromal tumor. Methods Applying the transrectal ultrasound to study the lesions of rectal stromal tumor and then analyze the perfusion features of lesions by pulse inversion harmonic imaging （PIH）. Results 9 cases of rectal stromal tumors were investigated in this study, including 3 cases of low-risk tumors, 1 case of moderate-risk tumor and 5 cases of high-risk tumors.On color Doppler ultrasound, rectal stromal tumors showed as hypoechoic mass with round or elliptic circular shapes, bulging outside or inside of the rectal cavity. In large tumors, clutter echoes, anechoic area and scattered calcifications with obvious boundary were detected, and most of the tumors bulge instead of extending on the gastrointestinal tract. With no obvious thickening of the gastrointestinal tract, lymphnode metastasis was not found near rectums either. Rapid enhancement showed on contrast-enhanced ultrasound and in larger tumors, relatively nonhomogeneous enhancement was detected while no enhancement was found in the lesion center. Conclusion Transrectal ultrasound combining with contrast-enhanced ultrasound can better display the morphology and microvascular perfusion state of rectal stromal tumors, which is of guiding significance to the preoperative diagnosis and the degree analysis of intestinal wall invasion.