HFUS+CDFI检查在胆囊息肉样病变诊断中的应用价值

The value of hfus+cdfi in the diagnosis of polypoid lesions of gallbladder

目的 探究高频超声(HFUS)+彩色多普勒血流成像(CDFI)检查在胆囊息肉样病变(PLG)诊断中的应用价值。方法 选取我院95例PLG患者(2019年1月-2020年10月)作为研究对象,均行HFUS、CDFI检查。比较良性、恶性病变CDFI参数[收缩期最大血流速度(Vmax)、阻力指数(RI)],以手术病理检查为“金标准”,统计HFUS、CDFI及HFUS+CDFI的检查结果、诊断效能,分析不同病理类型超声特征。结果 95例PLG患者经手术病理检查证实78例良性,其中63例胆囊息肉,9例胆囊腺肌增生症,6例胆囊腺瘤,17例恶性,均为小结节型胆囊癌;恶性病变Vmax、RI高于良性病变(P<0.05);HFUS+CDFI准确度、特异度、阳性预测值高于HFUS、CDFI,误诊率低于HFUS、CDFI(P<0.05),灵敏度、漏诊率、阴性预测值与HFUS、CDFI比较无统计学差异(P>0.05);胆囊息肉超声表现中等回声,基底狭窄有蒂;胆囊腺瘤超声表现中等或高回声,基底较宽、边界尚清;胆囊腺肌增生症超声表现为囊壁部分或完全性增厚,增厚部位为高回声,小结节型胆囊癌超声表现低或混合回声,局部囊壁增厚或中断,边界模糊,基底较宽、表面不光整。结论 HFUS+CDFI检查应用于PLG诊断中可提高诊断准确度、特异度、阳性预测值,降低误诊率,有助于指导临床治疗。

Objective To investigate the value of high frequency ultrasound(HFUS)and CDFI in the diagnosis of gallbladder polypoid disease(PLG).Methods 95 PLG patients(January 2019 to October 2020)were selected as the subjects of study, and HFUS and CDFI were examined.The CDFI parameters(Vmax)and RI of benign and malignant lesions were compared.Results The results and diagnostic efficacy of HFUS,CDFI and HFUS+CDFI were analyzed by using the“golden standard”of operation and pathology.result The results showed that 78 cases of benign were confirmed by operation and pathology in 95 PLG patients, including 63 cases of gallbladder polyps, 9 cases of adenomyosis, 6 cases of gallbladder adenoma, 17 cases of malignant, all of them were small nodule type gallbladder cancer;the Vmax and RI of malignant lesions were higher than benign ones(P<0.05);the accuracy, specificity and positive predictive value of HFUS+CDFI were higher than HFUS and CDFI,the misdiagnosis rate was lower than HFUS and CDFI(P<0.05),sensitivity was lower than HFUS and CDFI(P<0.05)The results showed that there was no significant difference between missed diagnosis rate and negative predictive value compared with HFUS and CDFI(P>0.05);the gallbladder polyp showed moderate echo and had a base stenosis with pedicle;the ultrasound of gallbladder adenoma showed medium or high echo, and the base was wide and the boundary was clear;the ultrasonic manifestations of adenomyosis of gallbladder were partial or complete thickening of the cystic wall, the thickening site was high echo, and the ultrasound of small nodular gallbladder carcinoma was low Or mixed echo, local wall thickening or interruption, fuzzy boundary, wider basement, and uneven surface.Conclusion HFUS+CDFI can improve the accuracy, specificity and positive predictive value of PLG diagnosis, reduce the misdiagnosis rate, and help to guide clinical treatment.