胆囊良恶性病变超声造影征象及鉴别诊断分析

Contrast-enhanced ultrasound signs and differential diagnosis of benign and malignant gallbladder lesions

目的察研究胆囊良恶性病变的超声造影征象及鉴别诊断价值。方法60例胆囊息肉样病变患者,根据手术病理结果分为肿瘤组与非肿瘤组,各30例。术前对胆囊息肉病变患者进行常规超声和超声造影检查,比较两组常规超声特征、超声造影特征、超声造影增强时间(开始时间、达峰时间、消退时间、平均渡越时间)以及两种检查方法诊断的准确性、敏感性。结果两组患者的息肉回声情况和血液流动状态比较,差异有统计学意义(P<0.05)。肿瘤组患者超声造影显示基底部宽度(3.79±1.67)mm,血管不规则6例、血管规则24例,高增强25例、非高增强5例,胆囊壁完整19例、胆囊壁不完整11例;非肿瘤组患者超声造影显示基底部宽度(2.20±0.57)mm,血管不规则1例、血管规则29例,高增强7例、非高增强23例,胆囊壁完整26例、胆囊壁不完整4例。两组患者息肉基底部宽度、内部血管情况、增强情况以及胆囊壁完整情况比较,差异有统计学意义(P<0.05)。肿瘤组患者开始时间(15.3±2.1)s、达峰时间(28.2±3.5)s均长于非肿瘤组的(12.4±2.4)、(22.6±3.2)s,消退时间(37.8±7.2)s、平均渡越时间(9.7±4.0)s短于非肿瘤组的(47.0±9.5)、(22.3±6.5)s,差异均具有统计学意义(P<0.05)。常规超声诊断的准确性63.3%、敏感性50.0%均低于超声造影的86.7%、80.0%,差异均具有统计学意义(P<0.05)。结论超声造影可显示胆囊良恶性病变血流特征和胆囊壁的连续性情况,对辅助鉴别病变性质具有较高的临床应用价值。

Objective To study the contrast-enhanced ultrasound signs and differential diagnostic value of benign and malignant gallbladder lesions.Methods A total of 60 patients with polypoid lesion of gallbladder were divided into a tumor group and a non-tumor group according to the surgical pathological findings,with 30 patients in each group.Patients with polypoid lesion of gallbladder were observed by conventional ultrasound and contrast-enhanced ultrasound before surgery,and the conventional ultrasound features,contrast-enhanced ultrasound features,contrast-enhanced ultrasound enhancement time(start time,peak time,fade time,mean crossing time),diagnostic accuracy and sensitivity of the two methods were compared.Results The differences in the echogenicity of polyps and blood flow status between the two groups were statistically significant(P<0.05).In the tumor group,contrast-enhanced ultrasound showed that the base width was(3.79±1.67)mm,the blood vessels were irregular in 6 cases,the blood vessels were regular in 24 cases,25 cases with high enhancement,5 cases without high enhancement,19 cases with intact gallbladder wall,and 11 cases with incomplete gallbladder wall;in the non tumor group,contrast-enhanced ultrasound showed that the base width was(2.20±0.57)mm,the blood vessels were irregular in 1 case,the blood vessels were regular in 29 cases,7 cases with high enhancement,23 cases without high enhancement,26 cases with intact gallbladder wall,and 4 cases with incomplete gallbladder wall.The differences in base width,the internal vascularity,the enhancement and the integrity of the gallbladder wall were statistically significant when compared between the two groups(P<0.05).The onset time(15.3±2.1)s and peak time(28.2±3.5)s in the tumor group were longer than(12.4±2.4)and(22.6±3.2)s in the non-tumor group;the fade time(37.8±7.2)s and the mean crossing time(9.7±4.0)s in the tumor group were shorter than(47.0±9.5)and(22.3±6.5)s in the non-tumor group;the differences were all statistically significant(P<0.05).The diagnostic accuracy 63.3%and sensitivity 50.0%by conventional ultrasound were lower than 86.7%and 80.0%by contrast-enhanced ultrasound,and all differences were statistically significant(P<0.05).Conclusion Contrast-enhanced ultrasound can show the blood flow characteristics of benign and malignant gallbladder lesions and the continuity of gallbladder wall,which is of high clinical value to assist in identifying the nature of lesions.