二维超声及超声造影在腹膜后节细胞神经瘤诊断中的价值

Application of two-dimensional ultrasound and contrast-enhanced ultrasound in diagnosis of retroperitoneal ganglioneuroma

目的:分析腹膜后节细胞神经瘤(retroperitoneal ganglioneuroma,RGN)的二维超声及超声造影(contrast-enhanced ultrasound,CEUS)表现特征,以期提高其术前诊断准确度。方法:收集并分析2012年1月—2022年12月于复旦大学附属中山医院经病理学检查证实为RGN的12例患者的超声图像,其中8例患者行CEUS检查,观察病灶的增强方式、增强强度,以及不同增强时相的表现特点。结果:12例患者病灶均为单发,12个病灶均呈低回声,周边均见高回声包膜,8个病灶内部回声欠均匀,4个病灶内部回声尚均匀,其中7个病灶内部伴有点状钙化。8个病灶形态不规则,4个病灶形态规则呈椭圆形。4个病灶边界尚清,8个病灶边界欠清。彩色多普勒血流成像测及7个病灶内部少量点状彩色血流。超声造影显示5个病灶动脉期呈轻度整体均匀增强,1个轻度整体不均匀增强,2个病灶呈周边为主不均匀轻度增强,8个病灶静脉期及延迟期缓慢减退呈低回声。结论:RGN二维超声多表现为不均匀低回声团块,伴高回声包膜,点状钙化具有一定特征,形态不规则,呈“泪滴状”时较具提示作用,病灶虽大但是彩色多普勒血流成像测及血流信号少,超声造影后病灶多表现为轻度强化,静脉期及延迟期缓慢减退。

Objective:To analyze the characteristics of two-dimensional ultrasound and contrast-enhanced ultrasound(CEUS)of retroperitoneal ganglioneuroma(RGN)for improving its preoperative diagnostic accuracy.Methods:The ultrasonic images of 12 patients with RGN confirmed pathologically in Zhongshan Hospital,Fudan University from January 2012 to December 2022 were collected for analysis.Eight patients underwent CEUS examination.The enhancement method,enhancement intensity and performance characteristics in different enhancement phases were observed.Results:Twelve patients had a total of 12 lesions,all of which were single.Twelve lesions were hypoechoic and hyperechoic capsules were seen around them.The internal echo of 8 lesions was uneven and 4 lesion was uniform.Seven lesions were accompanied by punctate calcification.Eight lesions were irregular in shape and 4 lesions were regular in oval shape.Four lesions had clear borders and 8 lesion had unclear border.Color Doppler flow imaging(CDFI)detected a small amount of punctate color blood flow inside 7 lesions.In the arterial phase,5 lesions showed mild overall uniform enhancement,1 had mild overall uneven enhancement,and 2 lesions showed mild peripheral uneven enhancement on CEUS.All 8 lesions gradually decreased and showed hypoechoic in the venous phase and the delayed phase.Conclusion:RGN is mostly manifested as an inhomogeneous low-echo tumor with a high-echo capsule on two-dimensional ultrasound.Spotty calcification has certain characteristics,with irregular morphology,and is more suggestive when it appears in a“tear-drop”shape.Although the lesion is large,there is little blood flow signal detected by CDFI.On CEUS,the lesion often shows mild enhancement,with slow regression in the venous and delayed phases.