超声造影鉴别直径≥1 cm胆囊病变良恶性的价值分析

doi:10.16139/j.1007-9610.2023.06.012

摘要/Abstract

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。

关键词: 超声造影, 胆囊病变, 胆囊癌, 增强模式, 鉴别诊断

Abstract:

Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in differential diagnosis between benign and malignant gallbladder lesions which diameter more than 1 cm. Methods A retrospective analysis included CEUS data of 142 cases with gallbladder lesions diameter more than 1 cm. All lesions were confirmed by surgical pathology, enhanced CT/MRI or clinical diagnosis with following up more than 2 years. To summarize the CEUS characteristics of benign and malignant gallbladder lesions over 1 cm in diameter, the CEUS characteristics of benign and malignant gallbladder lesions diameter more than 1 cm were analyzed, referring to the gallbladder CEUS guidelines. The contrast medium washout before 35 s and 60 s were used as the combined diagnosis with CEUS standard to identify gallbladder cancer, and the diagnostic efficiency was calculated respectively. Results There were statistical differences between the malignant group and the benign group in terms of CEUS enhancement pattern, contrast arrival time, washout time, and gallbladder wall continuity, as well as enhancement levels (P<0.001). The sensitivity, specificity, accuracy in the diagnosis of gallbladder malignant lesions were 93.0%, 83.8%, and 86.6% based on CEUS standard. The sensitivity, specificity and accuracy of diagnosis gallbladder malignant lesions were increased to 93.0%, 92.9% and 93.0% when combined with washout before 35 s of contrast medium. Conclusions CEUS is highly valuable in differentiating benign and malignant gallbladder lesions diameter more than 1 cm. Combined with contrast medium washout before 35 s is helpful to improve the ability of differentiating benign and malignant gallbladder lesions.

Key words: Contrast-enhanced ultrasound, Gallbladder lesions, Gallbladder cancer, Enhancement pattern, Differential diagnosis

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.

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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)

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)

Gold standard	CEUS standard		CEUS standard combined with contrast medium washout before 60 s		CEUS standard combined with contrast medium washout before 35 s
Gold standard	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

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