经直肠超声造影鉴别膀胱良恶性病变的诊断价值

The evaluating diagnosis of differentiation between malignant and benign bladder lesions by using transrectal contrast-enhanced ultrasound

目的:经直肠超声造影观察膀胱良恶性病变的声像图特点,研究经直肠超声造影对膀胱良恶性病变的鉴别诊断价值。方法:回顾性分析53例病人65个膀胱占位性病变的经直肠超声造影声像图,采用时间-强度软件测量超声造影定量参数并分析各自的增强模式及定量参数特征,与病理结果对照。结果:经直肠超声造影诊断51个膀胱恶性病变,14个良性病变。病理诊断49个膀胱恶性肿瘤,16个良性病变。膀胱良恶性肿瘤的峰值强度(P=0.000)和廓清时间(P=0.000)有统计学意义,到达时间(P=0.237)和达峰时间(P=0.291)差异无统计学意义。经直肠超声造影诊断膀胱恶性肿瘤的符合率为95.3%,灵敏度为97.9%,特异度为87.5%,阴性预测值为93.3%,阳性预测值为96.0%。结论:经直肠造影造影检查鉴别诊断膀胱良恶性病变的价值优于常规超声,“快进慢退”高增强模式结合峰值强度及廓清时间界值点鉴别膀胱恶性病变有较高的诊断价值。

Objective To investigate the characteristics of bladder occupied lesions in transrectal contrast-enhanced ultrasound and to explore the clinical diagnostic value of transrectal contrast-enhanced ultrasound(CEUS).Methods Transrectal contrast-enhanced ultrasound images of 65 bladder lesions in 53 patients were retrospectively analyzed.The dynamic images were analyzed by time-intensity curve.To analyze the pattern and Parameter characteristics of CEUS in benign and malignant bladder lesions and compare it with pathological results.Results In the 65 lesions,51 lesions were diagnosed as malignant,14 lesions were benign by transrectal contrast-enhanced ultrasound;41 lesions were bladder carcinomas,16 lesions were benign by pathology.Both PI(P=0.000)and WT(P=0.000)were significantly higher in malignant group than in benign group,whereas AT(P=0.237)and TTP(P=0.291)showed no significant difference between these two groups.The coincidence rate,sensitivity,the specificity,negative predictive value and positive predictive value of transrectal contrast-enhanced ultrasound in the diagnosis of bladder malignant tumors were 95.3%,97.9%,87.5%,93.3%,96.0%,respective ly.Conclusions The diagnostic value of transrectal contrast-enhanced ultrasound for benign and malignant bladder lesions is significantly higher than that of conventional ultrasound.The enhancement mode of"fast wash-in and slow wash-out"combined with PI and WT is more valuable for diagnosis.