高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值

Value of high frame rate contrast-enhanced ultrasound in differential diagnosis of gallbladder polyp lesions

目的探讨高帧频超声造影(H-CEUS)对最大径为1.0~1.5 cm胆囊腺瘤性息肉和胆固醇性息肉的鉴别诊断价值。方法回顾性分析2021年8月至2023年4月解放军总医院第一医学中心76例最大径为1.0~1.5 cm胆囊息肉样病变患者的临床资料,所有患者均于胆囊切除术前行常规超声和H-CEUS检查。采用单因素分析(χ^(2)检验和U检验)比较腺瘤性息肉和胆固醇性息肉患者的临床资料、常规超声图像特征和H-CEUS图像特征的差异。采用二元Logistic回归筛选腺瘤性息肉的独立危险指标。绘制受试者工作特征(ROC)曲线比较常规超声和H-CEUS鉴别腺瘤性息肉的诊断效能。结果胆囊腺瘤性息肉23例,胆固醇性息肉53例。常规超声图像上腺瘤性息肉和胆固醇性息肉在息肉的纵横比、数量(多发)、点状强回声(有)和血流信号(有)方面比较[0.8(0.7,1.4)vs 1.8(1.3,2.1),60.87%vs 33.96%,30.43%vs 69.81%,82.61%vs 39.62%],差异具有统计学意义(Z=-3.892,P<0.001;χ^(2)=4.764,P=0.029;χ^(2)=10.202,P=0.001;χ^(2)=11.888,P=0.001)。H-CEUS发现开始增强时间(早于胆囊壁)、增强强度(高增强)、血管形态(点状+线状)、血管性基底宽度和胆囊壁完整性(完整)在腺瘤性息肉和胆固醇性息肉间的差异具有统计学意义[30.43%vs 3.77%,χ^(2)=10.921,P=0.003;86.96%vs 9.43%,χ^(2)=43.668,P<0.001;21.74%vs 92.45%,χ^(2)=39.697,P<0.001;3.2(2.5,4.0)mm vs 1.9(1.7,2.1)mm,Z=-5.682,P<0.001;82.61%vs 98.11%,χ^(2)=6.273,P=0.027]。Logistic回归分析显示,仅息肉的增强强度(OR=2.213,95%CI:1.249~55.890,P=0.029)、血管形态(OR=4.121,95%CI:1.224~13.873,P=0.022)和血管性基底宽度(OR=3.524,95%CI:1.089~11.405,P=0.036)是腺瘤性息肉的独立危险指标。H-CEUS鉴别诊断腺瘤性息肉的敏感度、特异度和准确性分别是91.30%、88.68%和92.11%,曲线下面积为0.918,常规超声鉴别诊断腺瘤性息肉的敏感度、特异度和准确性分别是73.91%、79.25%和77.63%,曲线下面积为0.766,H-CEUS较常规超声具有更高的诊断效能(Z=2.510,P=0.012)。结论H-CEUS能准确鉴别最大径为1.0~1.5 cm的腺瘤性息肉和胆固醇性息肉,为息肉患者选择合适治疗方式提供了更准确的超声诊断依据。

Objective To assess the value of high frame rate contrast-enhanced ultrasound(H-CEUS)in the differential diagnosis of gallbladder adenomatous polyps and cholesterol polyps with a maximum size from 1.0 to 1.5 cm.Methods From August 2021 to April 2023,76 patients with gallbladder polyp lesions with a maximum size from 1.0 to 1.5 cm in the First Medical Center,Chinese PLA General Hospital were retrospectively analyzed.All patients underwent conventional ultrasound and H-CEUS examination before cholecystectomy.The clinical information and conventional ultrasound and H-CEUS image characteristics were compared between adenomatous polyps and cholesterol polyps by univariate analysis(chi-square test and U test).The independent risk predictors of adenomatous polyps were identified by logistic regression analysis.The diagnostic performance of conventional ultrasound and H-CEUS in distinguishing adenomatous polyps from cholesterol polyps was compared by receiver operating characteristic(ROC)curve analysis.Results There were 23 cases of adenomatous polyps and 53 cases of cholesterol polyps.The height/width ratio,number(multiple),hyperechoic spot,and blood flow signal on conventional ultrasound were significantly different between adenomatous polyps and cholesterol polyps[0.8(0.7,1.4)vs 1.8(1.3,2.1),Z=-3.892,P<0.001;60.87%vs 33.96%,χ^(2)=4.764,P=0.029;30.43%vs 69.81%,χ^(2)=10.202,P=0.001;82.61%vs 39.62%,χ^(2)=11.888,P=0.001,respectively].On H-CEUS,enhancement time(prior to the gallbladder wall),enhancement intensity(high enhancement),vascular morphology(petechial+linear),vascular stalk width,and gallbladder wall integrity(intact)of adenomatous polyps were significantly different from those of cholesterol polyps[30.43%vs 3.77%,χ^(2)=10.921,P=0.003;86.96%vs 9.43%,χ^(2)=43.668,P<0.001;21.74%vs 92.45%,χ^(2)=39.697,P<0.001;3.2(2.5,4.0)mm vs 1.9(1.7,2.1)mm,Z=-5.682,P<0.001;82.61%vs 98.11%,χ^(2)=6.273,P=0.027,respectively].Logistic regression analysis demonstrated that enhancement intensity(odds ratio[OR]=2.213,95%confidence interval[CI]:1.249-55.890,P=0.029),vascular morphology(OR=4.121,95%CI:1.224-13.873,P=0.022),and vascular stalk width(OR=3.524,95%CI:1.089-11.405,P=0.036)were independent risk predictors of adenomatous polyps.The sensitivity,specificity,and accuracy of H-CEUS in distinguishing adenomatous polyps from cholesterol polyps were 91.30%,88.68%,and 92.11%,respectively,and the area under the curve was 0.918.The sensitivity,specificity,and accuracy of conventional ultrasound in distinguishing adenomatous polyps from cholesterol polyps were 73.91%,79.25%,and 77.63%,respectively,and the area under the curve was 0.766.H-CEUS had higher diagnostic performance than conventional ultrasound(Z=2.510,P=0.012).Conclusion H-CEUS can accurately distinguish adenomatous polyps and cholesterol polyps with a maximum size from 1.0 to 1.5 cm,providing more accurate ultrasound diagnostic evidence for patients with gallbladder polyp lesions to help them choose appropriate treatment means.