超声造影鉴别膀胱良恶性占位的诊断价值初探

The value of contrast enhanced ultrasound in differentiating benign and malignant bladder neoplasms

目的探讨超声造影鉴别膀胱良恶性占位的诊断价值。方法对2018年5月至2019年12月在深圳市龙岗区第三人民医院因膀胱占位行超声造影检查的15例患者共17个病灶进行分析,观察病变位置、大小、数目,肿块内是否有血流信号,超声造影是否有增强及造影剂到达时间,增强模式。结果 17个病灶中恶性病灶13个(膀胱乳头状尿路上皮癌12个、膀胱肉瘤样癌1个),良性病灶4个(腺性膀胱炎1个,膀胱沉积物或凝血块3个),病灶大小(2.8±1.5)cm。超声造影诊断恶性病灶准确率高于常规超声(χ2=0.215,P=0.046)。膀胱乳头状尿路上皮癌超声造影到达时间为(20.7±6.0)秒,增强模式为均匀高增强、缓慢慢退;膀胱肉瘤样癌超声造影到达时间为13秒,增强模式为均匀高增强、快速消退;腺性膀胱炎超声造影到达时间为24秒;3个膀胱凝血块表现为无增强。结论超声造影能明显提高常规超声对膀胱占位的检出和鉴别诊断能力。

Objective To evaluate the value of contrast enhanced ultrasound in differentiating benign and malignant bladder neoplasms. Methods From May 2018 to December 2019, 17 lesions of 15 patients with bladder neoplasms, underwent contrast enhanced ultrasound(CEUS) in the Third Hospital of Longgang were included. The location, size, number, color doppler, arrival time and enhanced mode of CEUS were observed. Results Among the 17 lesions, 13 were malignant(12 bladder papillary urothelial carcinoma, 1 bladder sarcomatoid carcinoma), 4 were benign(1 cystitis glandular, 3 bladder deposits or clots), and the mean size was(2.8±1.5) cm. The accuracy of CEUS was higher than conventional ultrasound in diagnosing bladder malignant neoplasms(χ2=0.215, P=0.046). The arrival time of CEUS was(20.7±6.0) s in bladder papillary urothelial carcinoma with fast wash-in and slow wash-out. That was 13 s in bladder sarcomatoid carcinoma with fast wash-in and fast washout. That was 24 s in cystitis glandular. The bladder deposits or clots showed no wash-in. Conclusion Contrast enhanced ultrasonography improve the ability of conventional ultrasound in detecting and differentiating urinary bladder neoplasms.