超声造影对直径≥1.0cm胆囊息肉样病变的鉴别诊断价值

Contrast-enhanced ultrasound in the evaluation of gallbladder polypoid lesions larger than 1.0cm

目的探讨超声造影对直径≥1.0 cm的胆囊息肉样病变的鉴别诊断。方法选取2014年5月至2015年12月在解放军总医院就诊的胆囊息肉样病变患者106例,息肉直径≥1.0 cm。患者于术前行胆囊息肉样病变超声造影检查,记录造影动态图像。造影图像分析由2位医师采用盲法完成。根据手术病理结果将研究对象分为肿瘤性息肉组与非肿瘤性息肉组。2组间年龄、息肉直径、息肉基底部宽度等采用t检验;2组间性别,息肉数目、回声、部位及血流情况、胆囊结石、息肉血管形态,增强模式及程度,胆囊壁完整性等计数资料采用χ2检验,多变量的回归分析采用Logistic回归统计方法。结果肿瘤性息肉组与非肿瘤性息肉组组间息肉最大直径及彩色血流情况比较,差异均有统计学意义(t=-5.714,χ2=17.609,P均<0.01)。2组间在息肉基底部宽度,点状及分支样血管形态、增强程度、胆囊壁结构完整性方面比较,差异均有统计学意义(χ2=12.527、15.502、22.403、15.403,P均<0.01)。多因素回归分析结果表明,息肉基底部宽度、分支型血管结构是诊断肿瘤性息肉的独立风险因素。超声造影鉴别诊断胆囊肿瘤性息肉与非肿瘤性息肉的敏感度及特异度分别为86.4%、91.7%,阳性预测值为73.1%,阴性预测值为96.3%,诊断符合率90.6%。结论对于直径≥1.0 cm的胆囊息肉样病变,超声造影在鉴别肿瘤性息肉与非肿瘤性息肉有较高的临床应用价值,有助于临床医生选择合适的治疗方法。

Objective To evaluate the usefulness of contrast-enhanced ultrasound（CEUS） in the diagnosis of gallbladder polyp lesion（GPL） with the size larger than 1.0 cm. Methods From May 2014 to December 2015, all patients with GPL larger than 1.0 cm in diameter were enrolled in study. All relevant imaging information on gray-scale US and CEUS were documented. Based on the final histopathological results, the patient′s age, gender, size, number, echogenicity, location, vascularity, stalk width, enhancement intensity and mode of GPL, gallbladder wall continuity and gallbladder stone between non-neoplastic polyp group and neoplastic polyp group were analyzed for evaluating the diagnostic value of CEUS. Results A total of 106 patients were enrolled in this study. There were difference in size and blood flow of GPL between two groups（t=-5.714, χ2=17.609, P 0.01）. The stalk width of the GPL, spotty or branching vascular pattern on CEUS, the degree of enhancement on CEUS and gallbladder wall continuity were significantly different between neoplastic and non-neoplastic groups（χ2=12.527, 15.502, 22.403 and 15.403, P 0.01）. Stalk width of the GPL and branching vascular pattern were two independent risk factors according to multivariate statistical analysis. CEUS had a sensitivity of 86.4%, a specificity of 91.7%, a positive predictive value of 73.1%, a negative predictive value of 96.3%, and a diagnostic accuracy of 90.6%. Conclusion CEUScan provide adequate information about microcirculation and perfusion of the GBPL and gallbladder wall condition for lesions larger than 1.0 cm.