超声造影对胆囊壁增厚型病变的诊断价值

Value of contrast-enhanced ultrasound in diagnosis of gallbladder wall thickening lesions

目的探讨超声造影(CEUS)在良恶性胆囊壁增厚性病变术前诊断与评估中的应用价值,并与常规超声(US)、增强CT(CE-CT)、增强MRI(CE-MRI)、正电子发射计算机断层显像(PET/CT)进行对比。方法回顾性收集2022年8月至2023年8月复旦大学附属中山医院因胆囊壁增厚行胆囊切除术的患者103例,包括胆囊壁良性增厚患者77例(良性组)与胆囊壁恶性增厚患者26例(恶性组)。所有患者均在胆囊切除术前接受US及CEUS检查,并至少接受过CE-CT、CE-MRI或PET/CT中的一项检查,以病理结果为金标准。比较良性组与恶性组临床特征及超声图像特征的差异。绘制ROC曲线评估各影像学方法在鉴别良恶性胆囊壁增厚中的诊断性能,并通过Delong检验比较。评估US联合CEUS、CE-CT、CE-MRI及PET/CT在诊断胆囊壁恶性增厚组肝实质及周围淋巴结转移中的价值。结果良恶性组间患者的性别、年龄、胆囊壁厚度、造影剂是否廓清、动脉期强化程度及胆囊壁连续性差异有统计学意义(均P<0.05)。对诊断良恶性胆囊壁增厚型病变,CEUS的ROC曲线下面积(AUC)显著高于US(P<0.001),但与CE-CT、CE-MRI及PET/CT接近(P=0.084、0.065、0.426)。在评估胆囊壁恶性增厚型病变转移方面,US联合CEUS的对肝转移的检出率低于CE-CT及PET/CT,对淋巴结转移的检出率低于CE-CT、CE-MRI及PET/CT。结论CEUS对鉴别良恶性胆囊壁增厚型病变表现优异,显著优于US,并达到与CE-CT、CE-MRI及PET/CT相似的效能,但对于厚壁型胆囊癌的转移诊断率低于其他影像学检查。

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)in preoperative diagnosis and evaluation of benign and malignant gallbladder wall thickening diseases,and compare it with conventional ultrasound(US),contrast-enhanced CT(CE-CT),contrast-enhanced MRI(CE-MRI)and positron emission tomography/computed tomography(PET/CT).Methods A total of 103 gallbladder wall thickening patients who underwent cholecystectomy from August 2022 to August 2023 in Zhongshan Hospital of Fudan University were retrospectively collected,including 77 benign gallbladder wall thickening lesions(benign group)and 26 malignant gallbladder wall thickening lesions(malignant group).All patients underwent US and CEUS and at least one other imaging examination,including CE-CT,CE-MRI and PET/CT,and pathological results were taken as the reference standard.The ultrasound images and clinical characteristics between benign and malignant groups were compared.ROC curves were plotted to evaluate the performance of the methods,and the diagnostic efficiency of different methods was compared by Delong′s test.The value of US combined with CEUS,CE-CT,CE-MRI and PET/CT in the diagnosis of hepatic and peripheral lymph node metastases in patients with malignant gallbladder wall thickening was evaluated.Results There were significant differences in gender,age,thickening of gallbladder wall,contrast agent wash-out,arterial phase enhancement and continuity of gallbladder wall between benign and malignant groups(all P<0.05).The ROC area under the curve(AUC)of CEUS for discriminating cancer from benign gallbladder wall thickening lesions was higher than US(P<0.001),and was similar to CE-CT,CE-MRI and PET/CT(P=0.084,0.065,0.426).The diagnostic accuracy of US combined with CEUS in evaluating metastases of malignant gallbladder wall thickening was lower than CE-CT and PET/CT in hepatic metastases and lower than CE-CT,CE-MRI and PET/CT in lymphatic metastases.Conclusions CEUS has excellent diagnostic performance in benign and malignant gallbladder wall thickening lesions and its overall diagnostic efficiency is significantly superior to US,and similar to CE-CT,CE-MRI and PET/CT.However,the diagnostic accuracy of CEUS in thick-walled gallbladder carcinoma metastasis is lower than that of other imaging methods.