双通道超声造影在肝门部胆管癌分型及胆道低位梗阻病因诊断中的应用

Application of dual‑channel contrast‑enhanced ultrasound in classification of hilar cholangiocarcinoma and diagnosis of etiology of low biliary obstruction

目的探讨双通道超声造影(DCUS)在肝门部胆管癌分型及低位梗阻性黄疸病因诊断中的临床应用价值。方法回顾性收集2018年10月至2020年2月兰州大学第二医院超声科检查的114例梗阻性黄疸患者资料,男60例,女54例,年龄37~84(63±10)岁。所有患者术前行经静脉超声造影(CEUS),术中经穿刺针及术后经外置引流管行超声引导下的经皮肝穿胆管造影(UG‑PTC)和三维超声胆道造影(3D‑USC),即DCUS。根据DCUS图像特征判断肝门部胆管癌的分型、胆道低位梗阻的性质。所有接受过DCUS的患者均接受磁共振胰胆管造影(MRCP)及X线胆管造影检查。肝门部胆管癌分型以X线胆管造影为金标准,分析常规超声(US)、CEUS、DCUS的准确度。低位梗阻性黄疸定性以手术病理为金标准,分析US、CEUS、DCUS的诊断效能,同时用受试者工作特征(ROC)曲线比较MRI+MRCP与DCUS对胆道低位梗阻性质的判断效能。结果US、CEUS、DCUS对肝门部胆管癌分型诊断与X线胆管造影的符合率分别为:75.6%(34/45)、82.2%(37/45)、93.3%(42/45),US、CEUS、DCUS对低位胆道梗阻性质的判断与手术病理的符合率分别为:56.5%(39/69)、82.6%(57/69)、85.5%(59/69)。与US相比,CEUS对肝门部胆管癌分型诊断差异无统计学意义(P=0.438),DCUS对肝门部胆管癌分型诊断差异有统计学意义(P=0.039)。ROC曲线分析提示MRI+MRCP分级和DCUS分级诊断低位胆道梗阻的良恶性的临界值均为2.5级,曲线下面积(AUC)分别为0.897和0.906(均P<0.01),灵敏度和特异度分别为77.5%、93.1%和87.5%、82.8%。结论DCUS对肝门部胆管癌分型诊断和低位胆系梗阻的定性诊断性能与X线胆管造影、MRCP相当,在肝门部胆管癌分型及低位梗阻性黄疸病因诊断中有重要临床应用价值。

Objective To investigate the clinical value of dual‑channel contrast‑enhanced ultrasound(DCUS)in the classification of hilar cholangiocarcinoma and the diagnosis of the etiology of low obstructive jaundice.Methods The data of 114 patients with obstructive jaundice examined by the Department of Ultrasound of Lanzhou University Second Hospital from October 2018 to February 2020 were retrospectively collected.There were 60 males and 54 females,aged 37~84(63±10)years.All patients underwent preoperative transvenous contrast‑enhanced ultrasound(CEUS),intraoperative puncture needles,postoperative ultrasound‑guided percutaneous transhepatic cholangiocarcinography(UG‑PTC)and three‑dimensional ultrasound cholangiography(3D‑USC)through an external drainage tube,known as DCUS.The classification of hilar cholangiocarcinoma and the nature of low biliary tract obstruction were determined according to the characteristics of DCUS images.All patients who have received DCUS underwent magnetic resonance cholangiopancreatography(MRCP)and X‑ray cholangiography.X‑ray cholangiography was used as the gold standard for classification of hilar cholangiocarcinoma,and the accuracy of US,CEUS and DCUs was analyzed.Low obstructive jaundice was characterized by surgical pathology as the gold standard,and the diagnostic efficacy of conventional ultrasound(US),CEUS and DCUs was analyzed.At the same time,the receiver operating characteristic(ROC)curve was used to compare the efficacy of MRI+MRCP and DCUS in determination of the nature of low biliary obstruction.Results The coincidence rates of US,CEUS,and DCUS in the classification of hilar cholangiocarcinoma and X‑ray cholangiography were:75.6%(34/45),82.2%(37/45),and 93.3%(42/45),respectively.The coincidence rates of US,CEUS,and DCUS in the determination of the nature of low biliary obstruction and surgical pathology were 56.5%(39/69),82.6%(57/69),and 85.5%(59/69),respectively.Compared with conventional ultrasound,CEUS had no statistically significant difference in the diagnosis of hilar cholangiocarcinoma(P=0.438),and DCUS had statistically significant difference in the diagnosis of hilar cholangiocarcinoma(P=0.039).ROC curve analysis suggested that the cut‑off value of MRI+MRCP grade and DCUS grade for diagnosing benign and malignant low biliary obstruction were both 2.5;the area under the curve(AUC)were 0.897 and 0.906,respectively(both P<0.01);sensitivity were 77.5%and 93.1%,respectively;and the specificity were 87.5%and 82.8%,respectively.Conclusion The value of DCUS in the classification of hilar cholangiocarcinoma and the qualitative diagnosis of low biliary tract obstruction was comparable to that of X‑ray cholangiography and MRCP.DCUS had important clinical application value in the classification of hilar cholangiocarcinoma and the etiological diagnosis of low obstructive jaundice.