高频超声结合超声造影诊断咽食管憩室的价值

High-frequency ultrasound combined with contrast-enhanced ultrasound in the diagnosis of pharyngoesophageal diverticulum

目的探讨高频超声结合口服超声造影(CEUS)及经肘静脉CEUS对咽食管憩室的诊断价值。方法采用高频超声结合2种途径CEUS检查21例咽食管憩室,总结其常规超声及CEUS声像图特征。结果高频超声结合2种途径CEUS明确诊断21例咽食管憩室。高频超声常规声像图表现有3种:①类圆形低回声结节(3例,长径5~8 mm);②类圆形或类椭圆形低回声结节内伴点片状强回声区(4例,长径7~10 mm);③类圆形或类椭圆形不均匀高回声结节内伴点片状强回声区(14例,长径11~26 mm)。口服CEUS典型表现:患者吞咽时,可见造影剂悬浮液形成的强回声快速通过食管腔,并从食管腔呈窄带状强回声进人病灶内,吞咽间隔强回声部分消失,部分残留于病灶内,再次吞咽时强回声重复进人病灶内。经肘静脉CEUS典型表现:团注超声造影剂后,动脉早期病灶与食管壁同步增强,两者之间可见带状增强区相连。结论咽食管憩室常规声像图特征因憩室大小及内容物不同而有差异,口服CEUS及经肘静脉CEUS均具有典型的声像图特征。应用髙频超声结合2种途径CEUS检査可有效提高咽食管憩室的超声诊断准确率。

Objective To explore the diagnostic value of high frequency ultrasound combined with oral contrast-enhanced ultrasound(CEUS)and CEUS via elbow vein in pharyngoesophageal diverticulum.Methods A total of 21 cases of pharyngoesophageal diverticulum were examined by high frequency ultrasound combined with two ways of CEUS.The characteristics of conventional ultrasonography and CEUS were summarized.Results Twenty—one cases of pharyngoesophageal diverticulum were diagnosed by high-frequency ultrasound combined with two ways of CEUS.There were three kinds of conventional sonograms of high frequency ultrasound:(1)quasi-circular hypoechoic nodule(3 cases,5-8 mm in length);(2)quasi-circular or similar to oval-shaped hypoechoic nodules with a patchy hyperechoic area(4 cases,7-10 mm in length);(3)quasi-circular or similar to oval-shaped inhomogeneous hyperechoic nodules with a patchy hyperechoic area(14 cases,11-26 mm in length).The typical manifestations of oral CEUS:when swallowing,the strong echo formed by contrast medium suspension quickly passed through the esophageal cavity and entered the lesion from the esophageal cavity with narrow band strong echo.The strong echo of swallowing interval disappeared partly and remained in the lesion.When swallowing again,the strong echo entered the lesion repeatedly.The typical manifestations of CEUS via elbow vein:after bolus injection of contrast-enhanced ultrasound agent,the early lesions of arteries and esophageal wall were enhanced synchronously,and banded enhancement areas could be seen between them.Conclusions The conventional sonographic features of pharyngoesophageal diverticulum vary with the size and contents of the diverticulum.Both oral CEUS and elbow vein CEUS have typical sonographic features.High-frequency ultrasound combined with two ways of CEUS can effectively improve the accuracy of ultrasound diagnosis for pharyngoesophageal diverticulum.