外科理论与实践 ›› 2023, Vol. 28 ›› Issue (06): 556-562.doi: 10.16139/j.1007-9610.2023.06.012
冯梅晶1, 任新平1,2(), 詹维伟1,2, 郑丽丽1, 李军建1
收稿日期:
2022-10-08
出版日期:
2023-11-25
发布日期:
2024-03-04
通讯作者:
任新平,E-mail: rxp11946@rjh.com.cn
FENG Meijing1, REN Xinping1,2(), ZHAN Weiwei1,2, ZHENG Lili1, LI Junjian1
Received:
2022-10-08
Online:
2023-11-25
Published:
2024-03-04
摘要:
目的: 探讨超声造影,即对比增强超声(contrast-enhanced ultrasound,CEUS)对于鉴别直径≥1 cm胆囊病变良、恶性的价值。方法: 对经手术病理确诊、增强CT/MRI检查或随访2年以上临床诊断的142个直径≥1 cm胆囊病变的CEUS资料,进行回顾性分析,总结直径1 cm以上胆囊良、恶性病变的CEUS特性,参考胆囊CEUS相关指南标准计算鉴别胆囊病变良、恶性诊断效能,并将CEUS标准分别与造影剂35 s前消退、60 s前消退联合,计算相应的诊断效能。结果: 恶性组CEUS增强模式、增强开始时间、增强消退时间、胆囊壁连续性等方面与良性组比较,差异均有统计学意义(P<0.001)。良、恶性组总体增强水平的差异有统计学意义(P<0.001)。依据CEUS标准诊断胆囊恶性病变的灵敏度93.0%、特异度83.8%、准确率86.6%。CEUS标准联合造影剂35 s前消退诊断胆囊恶性病变的灵敏度、特异度、准确率上升至93.0%、92.9%、93.0%。结论: CEUS鉴别直径≥1 cm胆囊病变良、恶性有较高价值,结合35 s前造影剂消退有助于提高鉴别胆囊病变良恶性的能力。
中图分类号:
冯梅晶, 任新平, 詹维伟, 郑丽丽, 李军建. 超声造影鉴别直径≥1 cm胆囊病变良恶性的价值分析[J]. 外科理论与实践, 2023, 28(06): 556-562.
FENG Meijing, REN Xinping, ZHAN Weiwei, ZHENG Lili, LI Junjian. Value of contrast-enhanced ultrasound in differentiating benign and malignant gallbladder lesions which diameter more than 1 cm[J]. Journal of Surgery Concepts & Practice, 2023, 28(06): 556-562.
表1
胆囊病变良、恶性组的一般特征[M(IQR)/n(%)]
Characteristics | Malignant lesions (n=43) | Benign lesions (n=99) | Test statistic value | P value |
---|---|---|---|---|
Gross type (n/%) | χ2=56.480 | <0.001 | ||
Mass type | 9(20.9) | 85(85.9) | ||
Thick-walled type | 34(79.1) | 14(14.1) | ||
Characteristic | ||||
Diameter (mm) M(IQR) | 32.0(20.0) | 15.5(14.0) | Z=5.522 | <0.001 |
Quantity (n/%) | χ2=15.089 | <0.001 | ||
Single shot | 29(67.4) | 32(32.3) | ||
Multiple | 14(32.6) | 67(67.7) | ||
Form(n/%) | χ2=36.776 | <0.001 | ||
Rule | 12(27.9) | 80(80.8) | ||
Irregularity | 31(72.1) | 19(19.2) | ||
Echo (n/%) | χ2=14.529 | 0.002 | ||
Hyperechoic | 12(27.9) | 49(49.5)a) | ||
Hypoechoic | 10(23.3) | 4(4.0) a) | ||
Isoechoic | 14(32.6) | 30(30.3) | ||
Mixed echoic | 7(16.3) | 16(16.2) | ||
Gallbladder wall (n/%) | χ2=0.320 | 0.572 | ||
Thickening | 16(37.2) | 32(32.3) | ||
No thickening | 27(62.8) | 67(67.7) | ||
Gallbladder and liver boundary (n/%) | χ2=38.523 | <0.001 | ||
Clear | 21(48.8) | 93(93.9) | ||
Unclear | 22(51.2) | 6(6.1) | ||
Gallstone (n/%) | 0.553 | |||
Yes | 3(7.0) | 12(12.1) | ||
No | 40(93.0) | 87(87.9) |
表2
胆囊病变良、恶性组的CEUS特征[M(IQR)/n(%)]
Characteristics of CEUS | Malignant lesions (n=43) | Benign lesions (n=87) | Test statistic value | P value |
---|---|---|---|---|
Enhancement patterns (n/%) | χ2=30.658 | <0.001 | ||
Homogeneously | 8(18.6) | 61(70.1) | ||
Heterogeneously | 35(81.4) | 26(29.9) | ||
Enhancement level (n/%) | χ2=22.132 | <0.001 | ||
Hyperenhancement | 33(76.8) | 30(34.5)a) | ||
Isoenhancement | 5(11.6) | 14(16.1) | ||
Hypo-enhancement | 5(11.6) | 43(49.4)a) | ||
Contrast arrival time(s) M(IQR) | 15(6) | 18(6) | Z=10.753 | <0.001 |
Contrast washout time(s) M(IQR) | 45(29) | 64(40) | Z=3.794 | <0.001 |
Wall continuity (n/%) | χ2=41.611 | <0.001 | ||
Continuity | 18(41.9) | 81(93.1) | ||
Discontinuity | 25(58.1) | 6(6.8) |
表3
3种诊断方法与金标准的对比(n)
Gold standard | CEUS standard | CEUS standard combined with contrast medium washout before 60 s | CEUS standard combined with contrast medium washout before 35 s | |||||
---|---|---|---|---|---|---|---|---|
Malignant | Benign | Malignant | Benign | Malignant | Benign | |||
Malignant | 40 | 3 | 42 | 1 | 40 | 3 | ||
Benign | 16 | 83 | 40 | 59 | 7 | 92 | ||
κ value | 0.708 | 0.456 | 0.837 |
表4
3种方法的诊断效能(%)
Diagnostic effectiveness | CEUS standard | CEUS standard combined with contrast medium washout before 60 s | CEUS standard combined with contrast medium washout before 35 s |
---|---|---|---|
Sensitivity | 93.0 | 97.7 | 93.0 |
Specificity | 83.8 | 59.6 | 92.9 |
Positive predictive value | 71.4 | 51.2 | 85.1 |
Negative predictive value | 96.5 | 98.3 | 96.8 |
Accuracy | 86.6 | 71.1 | 93.0 |
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