超声造影在胆囊良恶性肿瘤鉴别诊断中的应用价值

Value of Contrast-Enhanced Ultrasound in Differential Diagnosis of Benign and Malignant Gallbladder Tumors

目的探讨超声造影(Contrast-enhanced Ultrasound,CEUS)在胆囊良恶性肿瘤鉴别诊断中的应用价值。方法以病理为标准,对97例胆囊肿瘤样病变患者进行超声造影,其中良性组68例,恶性组29例,观察胆囊肿瘤的超声造影灌注模式;对胆囊肿瘤进行时间-强度(TIC)曲线分析,记录以下定量指标:始增时间AT、峰值强度PI、达峰时间TTP、廓清起始时间、曲线下面积AUC、半洗出时间、半降支斜率、上升时间。结果 29例胆囊恶性肿瘤的超声造影灌注模式多表现为动脉早期快速不均匀增强,病灶基底部增宽,外形不规则,胆囊壁增厚,部分囊壁可见连续性中断,动脉中晚期或静脉早期快速廓清,呈"快进快退"。除6例胆泥表现为始终无增强,62例良性肿瘤超声造影灌注模式多表现为动脉早期快速均匀性增强,形态多规则,胆囊壁呈连续性增强,病灶基底部较窄或无基底部,静脉期缓慢廓清,呈"快进慢出"或"快进同出"。恶性组TIC曲线峰值强度、曲线下面积、半降支斜率绝对值均高于良性组(P<0.05),恶性组半洗出时间均小于良性组(P<0.05)。结论胆囊肿瘤的超声造影模式及TIC曲线定量参数在胆囊良恶性肿瘤的鉴别诊断中具有重要的应用价值。

Objective To evaluate the value of contrast-enhanced ultrasound （CEUS） in differential diagnosis of benign and malignant gallbladder tumors. Methods The CEUS was performed in 97 patients with pathology-confirmed gallbladder tumor-like lesions（68 patients with benign lesions and 29 patients with malignant lesions）. CEUS perfusion patterns were observed and time-intensity curve（TIC） was analyzed. The adding time（AT）,peak intensity（H）,time to peak（TTP） ,area under the curve（AUC）,half wash-out time,half descending slope and rise time were recorded. Results CEUS perfusion patterns of gallbladder malignancy showed uneven enhancement, widened lesion base, irregular shape, thickened gallbladder wall and continuous interruption of gallbladder wall in the early arterial phase. In the middle and late arterial phases or early venous phase,CEUS perfusion patterns showed rapid expurgation that was like ＂fast-in and fast-out＂. No enhancement in biliary sludge was observed in 6 cases. In the early arterial phase, the CEUS of benign lesions exhibited rapid uniform enhancement, regular shape, continuous gallbladder wall enhancement, and narrower lesion base or no base. In the early venous phase, the CEUS of benign lesions showed slow expurgation that was like ＂fast-in and slow-out＂ or ＂fast-in and simultaneous-out＇. Compared with benign lesion group, the PI, AUC and absolute value of half descending slope increased but the half wash-out time decreased in malignant lesion group（P〈0.05）. Conclusion CEUS patterns and TIC parameters are important in the differential diagnosis of benign and malignant gallbladder tumors.