灰阶超声与彩色多普勒血流显像诊断胆囊息肉样病变

Diagnosis of Gallbladder Polypoid Lesions by Gray-scale Sonography and Color Doppler Flow Imaging

目的 :探讨灰阶超声 (BUS)与彩色多普勒血流显像 (CDFI)对胆囊息肉样病变 (小于 2 .5cm)的诊断价值。方法 :分析 72例胆囊息肉样病变 (息肉 4 8例 ,腺瘤 7例 ,腺肌增生 2例 ,小结节型胆囊癌 15例 )BUS与CDFI的声像图特征。结果 :胆囊息肉为多发、有蒂、乳头状高回声结节 ,CDFI血流分级以 0 1级为主 (占 85 .4 % ) ;胆囊腺瘤为单发、中或高回声结节 ,大多有蒂 ,CDFI血流分级以 12级为主 (占 85 .7% ) ;胆囊腺肌增生常为基底较宽、低回声结节 ,病灶内无血流信号 ;小结节型胆囊癌常为基底较宽、中或低回声结节 ,CDFI血流分级以 2 3级为主 (占 73.3% ) ;恶性组RI明显大于良性组 ,如以RI≥ 0 .6作为诊断恶性肿瘤的指标 ,其敏感性为 91.7% (11/ 12 ) ,特异性为 93.8% (30 / 32 ) ,准确性为 93.2 % (41/ 4 4)。结论 :BUS联合CDFI是诊断胆囊息肉样病变的有效方法。

Objective: To evaluate the diagnostic value of gray-scale sonography and color Doppler flow imaging in gallbladder polypoid lesions. Methods: The imaging features were analysed in 72 patients with gallbladder polypoid lesions, including 15 patients with cancer, 48 with polys, 7 with adenomas, 2 with adenomyomatoses. Results: Polys appeared as multiple, pedunculated hyperechoic lesions on ultrasonographty and color signals were scored as 0~Ⅰin 85.4% of 48 lesions. Adenomas appeared as solitary, pedunculated lesions and color signals were scored as Ⅰ~ Ⅱin 85.7% of 7 lesions. All adenomyomatoses showed sessile hypoechoic lesions and color signals were absent. Adenocarcinomas appeared as solitary, sessile hypoechoic lesions and color signals were scored as Ⅱ~ Ⅲ in 73.3% of 15 lesions. The resistive index (RI) in maligant lesions was much higher than that in benign lesions. When RI within lesions higher than 0.60 was adopted as diagnostic criteria of gallbladder cancer, the sensitivity, specificity, and accuracy of the ultrasound in diagnosis of gallbladder cancer were 91.7%, 93.8% and 93.2% respectively.Conclusion: Color Doppler flow imaging was useful in the differential diagnosis of gallbladder polypoid lesions in combination with gray-scale sonography.