超声造影靶向引导胃肠间质瘤穿刺活检的临床价值

Clinical value of contrast-enhanced ultrasound in guiding biopsy of gastrointestinal stromal tumors

目的探讨超声造影靶向引导胃肠间质瘤穿刺活检的应用价值。方法收集2015年6月至2020年2月重庆大学附属肿瘤医院超声医学科接受超声引导经皮穿刺活检的胃肠间质瘤患者29例,其中11例行常规超声引导穿刺活检,18例行超声造影靶向引导穿刺活检。超声造影检查观察记录增强模式、强度、增强消退时间、达峰时间及内部灌注特征,选择安全路径及高灌注实性区域进行靶向定位。每个肿块穿刺2~3次,所获组织达到病理学诊断要求为取材成功。比较常规超声组与超声造影组的取材成功率、取材阳性率、诊断符合率及穿刺后并发症情况。结果29例患者,胃肠间质瘤肿块最大径范围7.3~30.2 cm,平均(14.8±6.2)cm。超声造影引导者18例,均表现为不均匀高增强(18/18),内部多见造影剂无灌注区(17/18),部分可见粗大迂曲血管灌注(11/18),少数可见向心性灌注(4/18),开始增强时间(14.1±4.2)s,达峰时间(23.8±5.8)s,消退时间(32.3±8.8)s,肿块增强模式表现为"快进慢出"型。常规超声组11例穿刺活检取得组织条26条,超声造影组18例取得36条,取材成功率分别为69.2%、94.4%,取材阳性率分别为69.2%、94.4%,诊断符合率分别为72.7%、100.0%,超声造影组穿刺取材成功率、取材阳性率和诊断符合率均高于常规超声组,差异均有统计学意义(P=0.008、0.008、0.045)。2组术后均无严重并发症发生。结论体积较大的胃肠间质瘤超声造影具有一定的特征性表现,超声造影靶向引导胃肠间质瘤穿刺活检较常规超声引导效果更优,对术前定性诊断、指导胃肠间质瘤治疗具有一定的临床价值。

Objective To assess the value of contrast-enhanced ultrasound(CEUS)in guiding the biopsy of abdominal gastrointestinal stromal tumors(GISTs).Methods A total of 29 patients with gastrointestinal stromal tumors and receiving US-guided percutaneous biopsy were collected from June 2015 to February 2020 at the Department of Ultrasound Medicine of Chongqing University Cancer Hospital,among whom 11 patients underwent conventional ultrasound-guided biopsy and 18 underwent CEUS-guided percutaneous biopsy.The CEUS feature of masses were observed and recorded,including enhancement pattern,intensity,arrival time,time to peak,and internal perfusion characteristics.The high perfusion area was determined to be the biopsy target,and the safe pathway of puncture was selected.Each mass underwent 2 to 3 punctures,and if the obtained tissues achieved the requirements of pathological diagnosis,the needle biopsy was judged to be successful.The successful biopsy rate,positive sampling rate,pathological diagnosis coincidence rate,and complications were compared between the two groups.Results In 29 patients,the maximum diameter of GIST tumors ranged from 7.3 to 30.2 cm,with an average of(14.8±6.2)cm.Of cases guided by CEUS,all showed strong heterogeneous enhancement,17 had no contrast agent perfusion in internal areas,11 had bulky and pedantic vascular perfusion,and 4 had centripetal perfusion.The arrival time was(14.1±4.2)s,time to peak was(23.8±5.8)s,and wash-out time was(32.3±8.8)s.There were 26 tissue strips obtained by conventional ultrasound-guided biopsy from 11 cases,and 36 tissue strips obtained by CEUS-guided biopsy from 18 cases.The successful biopsy rates were 69.2%and 94.4%,the sampling positive rates were 69.2%and 94.4%,and the diagnosis coincidence rates were 72.7%and 100%,respectively.The successful biopsy rate,positive sampling rate,and pathological diagnosis coincidence rate in the CEUS-guided group were significantly higher than those of the conventional ultrasound-guided group(P=0.008,0.008,0.045).No severe complications occurred in either group.Conclusion Large GISTs have certain CEUS characteristics.CEUS is a better way of guiding percutaneous biopsy than conventional ultrasound,and has appreciated clinical value for the preoperative qualitative diagnosis and guiding the treatment of GIST.