厚壁型胆囊癌超声造影征象及诊断价值的研究
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摘要
目的研究厚壁型胆囊癌的超声造影特征,并评价其对胆囊癌的诊断价值。方法选取2014年7月至2017年10月在解放军总医院接受超声造影检查及手术切除的26例厚壁型胆囊癌及37例良性厚壁型病变患者的超声造影图像、临床资料及手术病理。观察不同超声造影征象诊断壁厚型胆囊癌的价值。厚壁型胆囊癌26例为恶性组,良性厚壁型占位37例为良性组,2组患者年龄、胆囊长度、宽度、胆囊壁厚度采用t检验,超声造影特征(胆囊壁增强强度、黏膜层形态、黏膜下低增强区)比较采用χ2检验。诊断性试验采用ROC曲线计算敏感度、特异度、阳性预测值、阴性预测值及准确性。结果恶性组胆囊壁厚度、年龄均大于良性组[(1.63±0.68)cm vs(0.96±0.55)cm,(63.7±10.1)岁vs(53.2±11.8)岁],差异均有统计学意义(t=3.70、4.32,P均<0.001)。恶性组超声造影表现为黏膜层形态不规则、胆囊壁高增强、黏膜下无低增强区,与良性组比较,差异均有统计学意义(χ~2=48.7、42.9、23.8,OR=9.25、6.17、2.47,P均<0.001)。黏膜层形态不规则、胆囊壁高增强、黏膜下无低增强区诊断厚壁型胆囊癌的敏感度均为100.0%,准确性分别为93.7%、90.5%、76.2%。前2项联合诊断(同时出现黏膜形态不规则与胆囊壁高增强诊断厚壁型胆囊癌)准确性可进一步提高至98.4%。结论超声造影有助于胆囊厚壁型病变的良恶性鉴别,具有较高的诊断价值。
Objective To investigate the contrast enhanced ultrasound(CEUS) characteristics of thickened wall type of gallbladder carcinoma and to evaluate their diagnostic value. Methods The CEUS images, clinical information and pathological results of 26 patients with thickened wall type of gallbladder carcinoma and 37 patients having benign gallbladder disease with thickened wall were retrospectively analyzed. CEUS characteristics of thickened wall type of gallbladder carcinoma were investigated and their diagnostic value was evaluated. The age, length of gallbladder, width and thickness of gallbladder wall were analyzed by t test. The CEUS characteristics of gallbladder wall(intensity of gallbladder wall, mucosal morphology and submucosal hypo-enhancement area) were analyzed by χ2 test. The diagnostic test used ROC(receiver operating characteristic) curve to calculate sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Results The gallbladder wall thickness and patient age in malignant group were all larger than those in benign group [(1.63±0.68) cm vs(0.96±0.55) cm,(63.7±10.1) years old vs(53.2±11.8) years old], with statistically significant difference(t=3.70, 4.32, all P < 0.001). In the malignant group, CEUS showed irregular mucosal, hyper-enhancement and sub-mucosal hypo-enhancement area, with statistically significant difference(χ~2=48.7, 42.9, 23.8, OR=9.25, 6.17, 2.47, all P < 0.001). The sensitivity of irregular mucosa, hyper-enhancement and sub-mucosal hypo-enhancement area were all 100.0%, and their accuracy were 93.7%, 90.5% and 76.2% respectively. If lesions with both irregular mucosa and hyper-enhancement were diagnosed as thickened wall type of gallbladder carcinoma, the diagnostic accuracy could be further improved to 98.4%. Conclusion CEUS can facilitate the differential diagnosis of benign and malignant gallbladder diseases with thickened wall in a high diagnostic value.
Objective To investigate the contrast enhanced ultrasound(CEUS) characteristics of thickened wall type of gallbladder carcinoma and to evaluate their diagnostic value. Methods The CEUS images, clinical information and pathological results of 26 patients with thickened wall type of gallbladder carcinoma and 37 patients having benign gallbladder disease with thickened wall were retrospectively analyzed. CEUS characteristics of thickened wall type of gallbladder carcinoma were investigated and their diagnostic value was evaluated. The age, length of gallbladder, width and thickness of gallbladder wall were analyzed by t test. The CEUS characteristics of gallbladder wall(intensity of gallbladder wall, mucosal morphology and submucosal hypo-enhancement area) were analyzed by χ2 test. The diagnostic test used ROC(receiver operating characteristic) curve to calculate sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Results The gallbladder wall thickness and patient age in malignant group were all larger than those in benign group [(1.63±0.68) cm vs(0.96±0.55) cm,(63.7±10.1) years old vs(53.2±11.8) years old], with statistically significant difference(t=3.70, 4.32, all P < 0.001). In the malignant group, CEUS showed irregular mucosal, hyper-enhancement and sub-mucosal hypo-enhancement area, with statistically significant difference(χ~2=48.7, 42.9, 23.8, OR=9.25, 6.17, 2.47, all P < 0.001). The sensitivity of irregular mucosa, hyper-enhancement and sub-mucosal hypo-enhancement area were all 100.0%, and their accuracy were 93.7%, 90.5% and 76.2% respectively. If lesions with both irregular mucosa and hyper-enhancement were diagnosed as thickened wall type of gallbladder carcinoma, the diagnostic accuracy could be further improved to 98.4%. Conclusion CEUS can facilitate the differential diagnosis of benign and malignant gallbladder diseases with thickened wall in a high diagnostic value.
引文
1 Lee TY,Ko SF,Huang CC,et al.Intraluminal versus infiltrating gallbladder carcinoma:clinical presentation,ultrasound and computed tomography[J].World J Gastroenterol,2009,15(45):5662-5668.
2 Lau CSM,Zywot A,Mahendraraj K,et al.Gallbladder Carcinoma in the United States:A Population Based Clinical Outcomes Study Involving 22,343 Patients from the Surveillance,Epidemiology,and End Result Database(1973-2013)[J].HPB Surg,2017,2017:1532835.
3 Shen HX,Song HW,Xu XJ,et al.Clinical epidemiological survey of gallbladder carcinoma in northwestern China,2009-2013:2379 cases in 17 centers[J].Chronic Dis Transl Med,2017,3(1):60-66.
4 刘学,姚延峰,杜瑛,等.超声造影对胆囊内实性占位病变的鉴别诊断价值[J].临床超声医学杂志,2014,16(3):167-170.
5 费翔,罗渝昆,唐杰,等.超声造影对直径≥1.0 cm胆囊息肉样病变的鉴别诊断价值[J/CD].中华医学超声杂志(电子版),2016,13(10):746-751.
6 Zheng SG,Xu HX,Liu LN,et al.Contrast-enhanced ultrasound versus conventional ultrasound in the diagnosis of polypoid lesion of gallbladder:a multi-center study of dynamic microvascularization[J].Clin Hemorheol Microcirc,2013,55(3):359-374.
7 Fei X,Lu WP,Luo YK,et al.Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps:a prospective case-control study[J].Abdominal Imaging,2015,40(7):2355-2363.
8 Joo I,Lee JY,Kim JH,et al.Differentiation of adenomyomatosis of the gallbladder from early-stage,wall-thickening-typegallbladder cancer using high-resolution ultrasound[J].Eur Radiol,2013,23(3):730-738.
9 Gerstenmaier JF,Hoang KN,Gibson RN.Contrast-enhanced ultrasound in gallbladder disease:a pictorial review[J].Abdom Radiol(NY),2016,41(8):1640-1652.
10 Sun LP,Guo LH,Xu HX,et al.Value of contrast-enhanced ultrasound in the differential diagnosis between gallbladder adenoma and gallbladder adenoma canceration[J].Int J Clin Exp Med,2015,8(1):1115-1121.
11 徐辉雄,刘琳娜,郑曙光,等.胆囊超声造影临床应用指南(2012)解读[J/CD].中华医学超声杂志(电子版),2014,11(2):102-104.
12 Yuan H X,Wang W P,Wen J X,et al.Xanthogranulomatous cholecystitis:contrast-enhanced ultrasound features and differential diagnosis from wall-thickening gallbladder carcinoma[J].Discov Med,2016,21(114):89-98.
13 Nacif LS,Hessheimer AJ,Rodríguez Gómez S,et al.Infiltrative xanthogranulomatous cholecystitis mimicking aggressive gallbladder carcinoma:A diagnostic and therapeutic dilemma[J].World J Gastroenterol,2017,23(48):8671-8678.
14 苏晖,张波,刘翠云,等.超声造影对胆囊腺肌症的诊断价值[J/CD].中华医学超声杂志(电子版),2016,13(5):389-392.
15 王金环,徐辉雄,刘琳娜,等.胆囊腺肌增生症的超声造影表现分析[J].中国临床医学影像杂志,2016,27(3):177-179,197.
2 Lau CSM,Zywot A,Mahendraraj K,et al.Gallbladder Carcinoma in the United States:A Population Based Clinical Outcomes Study Involving 22,343 Patients from the Surveillance,Epidemiology,and End Result Database(1973-2013)[J].HPB Surg,2017,2017:1532835.
3 Shen HX,Song HW,Xu XJ,et al.Clinical epidemiological survey of gallbladder carcinoma in northwestern China,2009-2013:2379 cases in 17 centers[J].Chronic Dis Transl Med,2017,3(1):60-66.
4 刘学,姚延峰,杜瑛,等.超声造影对胆囊内实性占位病变的鉴别诊断价值[J].临床超声医学杂志,2014,16(3):167-170.
5 费翔,罗渝昆,唐杰,等.超声造影对直径≥1.0 cm胆囊息肉样病变的鉴别诊断价值[J/CD].中华医学超声杂志(电子版),2016,13(10):746-751.
6 Zheng SG,Xu HX,Liu LN,et al.Contrast-enhanced ultrasound versus conventional ultrasound in the diagnosis of polypoid lesion of gallbladder:a multi-center study of dynamic microvascularization[J].Clin Hemorheol Microcirc,2013,55(3):359-374.
7 Fei X,Lu WP,Luo YK,et al.Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps:a prospective case-control study[J].Abdominal Imaging,2015,40(7):2355-2363.
8 Joo I,Lee JY,Kim JH,et al.Differentiation of adenomyomatosis of the gallbladder from early-stage,wall-thickening-typegallbladder cancer using high-resolution ultrasound[J].Eur Radiol,2013,23(3):730-738.
9 Gerstenmaier JF,Hoang KN,Gibson RN.Contrast-enhanced ultrasound in gallbladder disease:a pictorial review[J].Abdom Radiol(NY),2016,41(8):1640-1652.
10 Sun LP,Guo LH,Xu HX,et al.Value of contrast-enhanced ultrasound in the differential diagnosis between gallbladder adenoma and gallbladder adenoma canceration[J].Int J Clin Exp Med,2015,8(1):1115-1121.
11 徐辉雄,刘琳娜,郑曙光,等.胆囊超声造影临床应用指南(2012)解读[J/CD].中华医学超声杂志(电子版),2014,11(2):102-104.
12 Yuan H X,Wang W P,Wen J X,et al.Xanthogranulomatous cholecystitis:contrast-enhanced ultrasound features and differential diagnosis from wall-thickening gallbladder carcinoma[J].Discov Med,2016,21(114):89-98.
13 Nacif LS,Hessheimer AJ,Rodríguez Gómez S,et al.Infiltrative xanthogranulomatous cholecystitis mimicking aggressive gallbladder carcinoma:A diagnostic and therapeutic dilemma[J].World J Gastroenterol,2017,23(48):8671-8678.
14 苏晖,张波,刘翠云,等.超声造影对胆囊腺肌症的诊断价值[J/CD].中华医学超声杂志(电子版),2016,13(5):389-392.
15 王金环,徐辉雄,刘琳娜,等.胆囊腺肌增生症的超声造影表现分析[J].中国临床医学影像杂志,2016,27(3):177-179,197.