超声造影联合二维超声检查在厚壁型胆囊癌患者诊断中的应用价值

Application Value of Contrast-Enhanced Ultrasound and Two-Dimensional Ultrasound in the Diagnosis of Patients with Thick-Walled Gallbladder Carcinoma

目的研究超声造影(CEUS)联合二维超声(2DUS)检查在厚壁型胆囊病变患者诊断中的应用价值。方法选取2018年2月至2021年2月太康县人民医院收治的62例厚壁型胆囊病变患者,均接受CEUS、2DUS检查,以病理检查为金标准,分为良性占位组(37例)和恶性占位组(25例),对比两组胆囊情况、不同厚壁型胆囊病变[慢性胆囊炎、胆囊腺肌症、厚壁型胆囊癌(GBC)]CEUS联合2DUS影像学特征、CEUS联合2DUS影像学表现。结果良性占位组胆囊宽度、胆囊壁厚度小于恶性占位组(P<0.05);3种厚壁型胆囊病变增强模式、胆囊内壁连续性、胆囊外壁连续性比较,差异有统计学意义(P<0.05);恶性占位组CEUS联合2DUS多表现为始增时间≤15 s(快进)、黏膜面形态不规则、胆囊壁高增强、消退时间≤36 s(快退),与良性占位组比较,差异有统计学意义(P<0.05);GBC诊断中快进、黏膜面形态不规则、胆囊壁高增强、快退均有较高价值,黏膜面形态不规则ROC曲线下面积(0.826)最高,联合诊断价值较高(P<0.05);CEUS联合2DUS诊断GBC的特异度为81.22%,敏感度为95.18%,准确度为86.79%。结论CEUS联合2DUS检查应用于GBC诊断,有利于鉴别厚壁型胆囊病变类型及其良恶性,具有临床推广价值。

Objective To study the application value of contrast-enhanced ultrasound(CEUS)and two-dimensional ultrasound(2DUS)in the diagnosis of patients with thick-walled gallbladder disease.Methods A total of 62 patients with thick-walled gallbladder disease admitted to Taikang County People’s Hospital from February 2018 to February 2021 were selected.All patients underwent CEUS and 2DUS examinations.Pathological examinations were used as the gold standard.The patients were divided into benign space-occupying groups(37 cases)and malignant space-occupying group(25 cases).The gallbladder conditions,different thick-walled gallbladder lesions[chronic cholecystitis,gallbladder adenomyosis,thick-walled gallbladder carcinoma(GBC)]CEUS and 2DUS imaging features,CEUS and 2DUS imaging performance were compared between the two groups.Results The width of the gallbladder and the thickness of the gallbladder wall in the benign space-occupying group were smaller than those in the malignant space-occupying group(P<0.05).There were differences in the three types of thick-walled gallbladder lesion enhancement modes,the continuity of the gallbladder inner wall and the continuity of the outer gallbladder wall(P<0.05).CEUS and 2DUS in the malignant space-occupying group mostly showed the initial increase time≤15 s(fast forward),irregular mucosal surface morphology,high gallbladder wall enhancement,and regression time≤36 s(fast retreat),which was different from the benign space-occupying group(P<0.05).In the diagnosis of GBC,fast forward,irregular mucosal surface morphology,high gallbladder wall enhancement,and rapid retreat were all of higher value.The area under the ROC curve of irregular mucosal surface(0.826)was the highest,and the combined diagnosis value was better high(P<0.05).The specificity of CEUS and 2DUS in the diagnosis of GBC was 81.22%,and sensitivity was 95.18%,and accuracy was 86.79%.Conclusion CEUS and 2DUS examination is helpful for distinguishing the types of thick-walled gallbladder lesions and their benign and malignant lesions in the diagnosis of GBC,and has clinical promotion value.