胆囊息肉样病变超声造影动脉期血管增强模式与息肉性质及大小的相关性

The correlation of contrast-enhanced ultrasound vascular mode with gallbladder polyp nature and size

目的探讨胆囊息肉样变(大小≥1.0 cm)超声造影动脉期血管增强模式与息肉性质及息肉大小的相关性。方法选取2014年12月至2016年5月到解放军总医院就诊的胆囊息肉样病变患者103例,选择息肉大小≥1.0 cm的患者纳入研究。患者于术前行胆囊息肉超声造影检查,记录造影动态图像。造影图像分析由2位医师独立完成。根据手术病理结果将研究对象分为腺瘤性息肉组(21例)与胆固醇性息肉组(82例)。采用t检验及X^2检验分析2组间常规超声特征与超声造影动脉期息肉血管增强模式的差异,采用Logistic回归方法统计分析与腺瘤性息肉相关的危险因素,采用Bivariate双变量相关分析法息肉血管增强模式与息肉大小的相关关系。结果腺瘤性息肉组与胆固醇性息肉组患者息肉大小及有无彩色血流比较(1.26±0.24 vs 1.72±0.53,27/82 vs 14/21),差异均有统计学意义(t=-5.97,X^2=7.94,P均<0.05)。2组患者在点状、分支状及不规则造影血管增强模式比较(39/82 vs 2/21,23/82 vs 13/21,0 vs 3/21),差异均有统计学意义(X^2=10.09、8.43,P<0.05)。多因素Logistic回归分析结果表明,息肉大小、分支型血管增强模式是诊断腺瘤性息肉的独立危险因素(P<0.05)。相关分析表明腺瘤性息肉组与胆固醇性息肉组造影血管增强模式与息肉大小呈弱正相关(r=0.188、0.397,P<0.05)。结论胆囊息肉样病变超声造影增强模式不仅反应息肉性质同时也与息肉大小有关,胆囊息肉大小及造影动脉期分支状血管增强模式对于鉴别胆固醇息肉与腺瘤性息肉有重要临床价值。

Objective To evaluate the correlation between enhancement vascular mode and gallbladder polyp nature and size with contrast-enhance ultrasound （CEUS）. Methods From December 2014 to May 2016, patients with gallbladder polyp lesions （GPL） larger than 1.0 cm were enrolled in this study. Before cholecystectomy, every patient underwent ultrasound （US） and CEUS examination. All features of US and CEUS were analyzed by two doctors who were blind to the patient clinical data. According to the pathological findings, GPL were divided into cholesterol polyp group and gallbladder adenoma group. The US features and enhancement vascular mode were analyzed statistically by t test and Z test. The independent risk factors were analyzed by Logistic regression. The relationship between enhancement vascular rood and size of GPL were determined by bivariate correlation analysis. Results There were 103 patients with GPL larger than 1.0 cm. Eighty-two cases were cholesterol polyp and 21 cases were gallbladder adenoma. There were differences in size and color Doppler blood flow between two groups （t=-5.97 and 7.94, P 〈 0.05）. Dotted, branched vascular mod and irregular vascular mode were statistical different between two groups （22=10.09 and 8.43, P〈0.05）. Regression analysis data proved that the size and branch vascular mod were the independent risk factors related with adenoma （P 〈 0.05）. In both cholesterol polyp group and adenoma group, there were weak positive correlation between enhancement vascular mode and size of GPL （r=0.188, 0.397, P 〈 0.05）. Conclusions Branch vascular rood and size of GPL were help to distinguish gallbladder adenoma from cholesterol polyp. Comprehensive analysis of GPL＇s size and vascular mode could offer important guidance for differentiation diagnosis.