超声造影在胆囊隆起样病变诊断中的应用进展

doi:10.16150/j.1671-2870.2023.01.011

摘要/Abstract

摘要：

胆囊隆起样病变分为肿瘤性病变和非肿瘤性病变两大类。肿瘤性病变包括胆囊腺瘤和胆囊癌；非肿瘤性病变包括胆固醇性息肉、炎性息肉、胆囊腺肌症等。常规超声检查是诊断胆囊病变的首选影像学方法，但诊断能力有限。随着医学技术的发展，超声造影在部分胆囊病变的应用中渐被认可。不同类型的胆囊隆起样病变在超声造影动脉期及静脉期病灶的增强程度、消退特点、增强模式、血管构型、胆囊壁的连续性方面表现不同。对比剂达峰时，病灶增强的均质性在鉴别胆囊腺瘤与1 cm以上胆固醇息肉有较高的诊断效能，其灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为100%、90.9%、92.9%、100%、95.8%。超声造影对胆囊腺肌症特征性结构罗-阿窦的显示率从常规超声的22.0%上升到56.1%；在胆囊腺瘤诊断中，超声造影检查具有较高的灵敏度和特异度，分别为84.6%和87.0%；超声造影诊断黄色肉芽肿性胆囊炎的灵敏度、特异度、阴性预测值分别为90%、93%、94%。病灶形态不规则、树枝状血管、静脉期低增强是提示胆囊腺癌的3个特异性超声造影征象，结合任意2个或3个征象，诊断胆囊癌的特异度可达92.4%。在胆囊隆起样病变的诊断中，超声造影表现具有一定特征，具有较高的应用价值。

关键词: 胆囊隆起样病变, 超声造影, 胆固醇性息肉, 胆囊癌

Abstract:

Gallbladder protrusion lesions(GPL) have two types:neoplastic lesions and non-neoplastic lesions. Neoplastic lesions include gallbladder adenoma and gallbladder carcinoma, while non-neoplastic lesions include cholesterol polyps, inflammatory polyps, gallbladder adenomyosis， etc. Conventional ultrasound examination is the preferred imaging examination for diagnosing GPL, however its diagnostic capacity is not satisfied. With the progress of medical technology, the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of some GPL has been recognized. Different types of GPL present different degrees of enhancement, regression characteristics, enhancement modes, vascular architecture, and continuity of gallbladder wall in the arterial and venous phases of CEUS. Many studies at home and abroad believe that CEUS plays an important role in the diagnosis and differential diagnosis of GPL. When the contrast medium reaches its peak, the enhanced homogeneity of the lesions has the highest diagnostic efficiency in differentiating gallbladder adenoma from cholesterol polyps with diameter over 1 cm. Its sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden’s J statistic are 100%, 90.9%, 92.9%, 100%, 95.8% and 0.91, respectively. The display rate of CEUS for the characteristic structure of gallbladder adenomyosis, the sinus, increases from 22.0% of conventional ultrasound to 56.1%.The sensitivity and specificity of CEUS in the diagnosis of gallbladder adenoma were 84.6% and 87.0%, respectively. CEUS has high sensitivity, specificity and negative predictive value in the diagnosis of xanthogranulomatous cholecystitis, which are 90%, 93% and 94% respectively.Irregular focus shape, dendritic vessels and low enhancement in venous phase are three specific signs of CEUS that suggests gallbladder adenocarcinoma. Combined with any two or three above signs, the specificity of CEUS for diagnosing gallbladder cancer may reach 92.4%. In the diagnosis of GPL,CUES may display certain characteristic manifestation and is worthy of clinical application.

Key words: Gallbladder protrusion lesions, Contrast-enhanced ultrasound, Cholesterol polyp, Gallbladder carcinoma

中图分类号:

R445.1

冯梅晶, 任新平. 超声造影在胆囊隆起样病变诊断中的应用进展[J]. 诊断学理论与实践, 2023, 22(01): 68-74.

FENG Meijing, REN Xinping. Application of contrast-enhanced ultrasound in diagnosis of gallbladder protrusion lesions[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(01): 68-74.

图/表 1

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病变	动脉期增强程度	静脉期	消退特点	胆囊壁	血管构型	增强模式	组织浸润
胆固醇息肉	同进，等或高增强	低增强	略早于胆囊壁，50 s以后消退	连续性好	点状/单支型/ 分支型	均匀增强	无
胆囊腺肌症	等增强或稍高增强或环形高增强，向内填充	等或略低增强	-	连续性好	点状	不均匀增强，内见无增强区	无
胆囊腺瘤	快进，高增强	低或等增强	消退缓慢，多大于50 s	连续性好	树样	均匀	无
黄色肉芽肿性胆囊炎	快进，高增强	稍低增强	消退缓慢，多大于80.5 s	内壁连续性好	-	均匀	炎症可波及邻近组织
胆囊癌	高增强，病灶内出现对比剂的时间有争议	低增强	消退时间有争议	可出现连续性中断、局部增厚或异常高增强	树枝状不规则	均匀或不均匀	可有肝脏浸润