超声造影定性诊断直肠肿物

Contrast-enhanced ultrasonography in qualitative diagnosis of rectal masses

目的分析超声造影(CEUS)对直肠肿物的定性诊断价值。方法对129例直肠肿物患者行常规经直肠超声(ERUS)及CEUS检查。以术后病理结果作为诊断金标准,对比术前ERUS与CEUS定性诊断直肠肿物的正确率,比较恶性、交界性(癌前病变)及良性病变间CEUS灌注参数及CEUS表现。结果 129例均为单发病变,其中恶性病变65例、癌前病变31例、良性病变33例。CEUS对直肠恶性病变、癌前病变及良性病变的正确诊断率均高于ERUS(P均<0.05)。恶性病变、癌前病变、良性病变及周围正常肠壁之间,CEUS到达时间(AT)、达峰时间(TTP)及峰值强度(PI)差异均有统计学意义(P均<0.001)。恶性病变CEUS多表现为动脉期快速强化,延迟期快速消退;癌前病变表现不一,多见不均匀高增强;良性病变动脉期、延迟期多呈高增强。结论 CEUS可用于定性诊断直肠肿物,且效果好于常规超声。

Objective To observe the value of contrast-enhanced ultrasonography(CEUS) in qualitative diagnosis of rectal masses. Methods Totally 129 cases of rectal masses underwent endorectal ultrasonography(ERUS) and CEUS. Postoperative pathological results were taken as the gold standards for diagnosis. The accuracy rate of preoperative ERUS and CEUS in qualitative diagnosis of rectal masses were compared. CEUS perfusion parameters and CEUS manifestations were compared among malignant, borderline(precancerous lesions) and benign lesions. Results All 129 patients were found with single lesion, including 65 with malignant lesios, 31 with precancerous lesion and 33 with benign lesion. The accuracy of CEUS in diagnosis of rectal malignant lesions, precancerous lesions and benign lesions were all higher than that of ERUS(all P<0.05). There were significant differences of arriving time(AT), time to peak(TTP) and peak intensity(PI) during CEUS among rectal malignant, precancerous, benign lesions and surrounding normal rectal wall(all P<0.001). CEUS manifestations of malignant lesions were mainly characterized by rapid enhancement in arterial phase and rapid regression in delayed phase, of precancerous lesions was various, most showed inhomogeneous high enhancement, whereas of most of benign lesions were homogeneous high enhancement in arterial phase and delayed phase. Conclusion CEUS could be used for qualitative diagnosis of rectal masses and had better effect than conventional ultrasound.