高帧频超声造影在鉴别诊断胆囊腺瘤性息肉与胆固醇性息肉中的临床应用

doi:10.3877/cma.j.issn.1672-6448.2020.09.001

目的

比较常规超声造影（CEUS）与高帧频超声造影（H-CEUS）在鉴别腺瘤性息肉与胆固醇性息肉中的诊断价值。

方法

收集2019年8月至2020年2月解放军总医院第一医学中心因胆囊息肉样病变（GPL）行腹腔镜胆囊切除术的患者65例。术前先行CEUS和H-CEUS，根据术后病理结果分为腺瘤性息肉组（16例）和胆固醇性息肉组（49例），比较2种检查方法对病变的灌注特征的显示和最终诊断。采用χ²检验比较2组之间以及CEUS和H-CEUS下的血管形态、增强强度和胆囊壁完整性的差异。

结果

CEUS对胆囊腺瘤性息肉和胆固醇性息肉的血管形态判断，差异无统计学意义（P>0.05）。CEUS观察到85.71%（42/49）的胆固醇性息肉和68.75%（11/16）的胆囊腺瘤性息肉血管形态表现为均匀点状。H-CEUS判断胆囊腺瘤性息肉和胆固醇性息肉之间的血管形态，差异具有统计学意义（χ²=26.527，P<0.001）。H-CEUS可观察到75.51%（37/49）的胆固醇性息肉和25.00%（4/16）的腺瘤性息肉血管形态表现为均匀点状。胆固醇性息肉组在CEUS和H-CEUS下的血管形态比较，差异无统计学意义（P>0.05），而腺瘤性息肉组，在CEUS和H-CEUS下的血管形态比较，差异具有统计学意义（χ²=7.878，P=0.019）。腺瘤性息肉组中CEUS仅能检测到6.25%（1/16）的分支血管形态，而H-CEUS能检测到43.75%（7/16）的分支血管形态。

结论

H-CEUS通过提高帧频来提高时间分辨率，有助于准确反映GPL微循环的差异，并提高胆固醇性息肉和腺瘤性息肉的鉴别诊断能力。在选择治疗方案时，H-CEUS可作为GPL诊断的有效影像学检查手段。

关键词: 超声造影, 胆囊息肉样病变, 胆囊腺瘤, 胆固醇性息肉

Objective

To compare the diagnostic value of conventional contrast-enhanced ultrasound (CEUS) and high-frame-rate CEUS (H-CEUS) in differentiating gallbladder adenomas from cholesterol polyps.

Methods

Sixty-five patients who underwent laparoscopic cholecystectomy for gallbladder polypoid lesions (GPL) at the First Medical Centre of Chinese PLA General Hospital from August 2019 to February 2020 were collected. Pre-operative CEUS and H-CEUS were performed in all patients. According to the pathological results, the patients were divided into either an adenoma group (16 cases) or a cholesterol polyp group (49 cases). The perfusion characteristics of the lesions and the final diagnosis were compared between the two methods and between CEUS and H-CEUS. The χ² test was used to compare the differences in vascular morphology, enhancement intensity, and gallbladder wall integrity between the two groups.

Results

CEUS had no statistical difference in judging the vascular morphology of gallbladder adenomas and cholesterol polyps (P>0.05). CEUS observed that 85.71% (42/49) of cholesterol polyps and 68.75% (11/16) of gallbladder adenomas showed uniform spot vascular structures. H-CEUS can significantly judge the difference in vascular morphology between gallbladder adenomas and cholesterol polyps (χ²=26.527, P<0.001). H-CEUS observed that 75.51% (37/49) of cholesterol polyps and 25.00% (4/16) of adenomas showed uniform spot vascular structures. There was no difference in the vascular morphology between CEUS and H-CEUS in the cholesteric polyp group (P>0.05), while the vascular morphology between CEUS and H-CEUS in the adenoma group was statistically different (χ²=7.878, P=0.019). In the adenoma group, CEUS can only detect 6.25% (1/16) of the branch vessel morphologies, while H-CEUS can detect 43.75% (4/16) of the branch vessel morphologies.

Conclusion

H-CEUS improves the temporal resolution by increasing the frame rate, which helps to accurately reflect the differences of GPL microcirculation and improves the differential diagnosis of cholesterol polyps and adenomas. In the selection of treatment plans, H-CEUS provides an effective imaging examination method for GPL patients.

Key words: Contrast-enhanced ultrasound, Gallbladder polyp lesion, Gallbladder adenoma, Cholesterol polyp

表1 胆囊息肉样病变患者一般情况及超声图像特征

组别	例数	年龄（岁，±s）	性别（男/女）	最大径（cm，±s）	回声特征（例）			数量（例）		血流信号（例）
组别	例数	年龄（岁，±s）	性别（男/女）	最大径（cm，±s）	高回声	等回声	低回声	单发	多发	有	无
胆固醇性息肉组	49	41.45±1.65	20/29	1.13±0.12	41	8	0	40	9	3	46
腺瘤性息肉组	16	45.37±3.42	11/5	1.57±0.14	9	6	1	13	3	14	2
统计值	?	t=1.456	χ²=3.773	t=9.173	χ²=6.974			χ²=0.001		χ²=41.357
P值	?	0.135	0.052	<0.001	0.031			0.973		<0.001

表1 胆囊息肉样病变患者一般情况及超声图像特征

组别	例数	年龄（岁，±s）	性别（男/女）	最大径（cm，±s）	回声特征（例）			数量（例）		血流信号（例）
组别	例数	年龄（岁，±s）	性别（男/女）	最大径（cm，±s）	高回声	等回声	低回声	单发	多发	有	无
胆固醇性息肉组	49	41.45±1.65	20/29	1.13±0.12	41	8	0	40	9	3	46
腺瘤性息肉组	16	45.37±3.42	11/5	1.57±0.14	9	6	1	13	3	14	2
统计值	?	t=1.456	χ²=3.773	t=9.173	χ²=6.974			χ²=0.001		χ²=41.357
P值	?	0.135	0.052	<0.001	0.031			0.973		<0.001

表2 CEUS和H-CEUS下胆固醇性息肉与腺瘤性息肉灌注特征（例）

检查方法	组别	例数	血管形态			增强强度		胆囊壁完整性
检查方法	组别	例数	点状	单支样	分支样	高增强	非高增强	完整	缺损
CEUS	胆固醇性息肉组	49	42	7	0	2	47	49	0
?	腺瘤性息肉组	16	11	4	1	11	5	13	3
?	χ²值	?	4.306			31.526		9.632
?	P值	?	0.116			<0.001		0.002
H-CEUS	胆固醇性息肉组	49	37	12	0	1	48	49	0
?	腺瘤性息肉组	16	4	5	7	15	1	13	3
?	χ²值	?	26.527			54.669		9.632
?	P值	?	<0.001			<0.001		0.002
χ²值^a	?	?	1.632			0.344		0.000
P值^a	?	?	0.201			0.558		1.000
χ²值^b	?	?	7.878			3.282		0.000
P值^b	?	?	0.019			0.070		1.000

表2 CEUS和H-CEUS下胆固醇性息肉与腺瘤性息肉灌注特征（例）

检查方法	组别	例数	血管形态			增强强度		胆囊壁完整性
检查方法	组别	例数	点状	单支样	分支样	高增强	非高增强	完整	缺损
CEUS	胆固醇性息肉组	49	42	7	0	2	47	49	0
?	腺瘤性息肉组	16	11	4	1	11	5	13	3
?	χ²值	?	4.306			31.526		9.632
?	P值	?	0.116			<0.001		0.002
H-CEUS	胆固醇性息肉组	49	37	12	0	1	48	49	0
?	腺瘤性息肉组	16	4	5	7	15	1	13	3
?	χ²值	?	26.527			54.669		9.632
?	P值	?	<0.001			<0.001		0.002
χ²值^a	?	?	1.632			0.344		0.000
P值^a	?	?	0.201			0.558		1.000
χ²值^b	?	?	7.878			3.282		0.000
P值^b	?	?	0.019			0.070		1.000

图1 胆固醇性息肉常规超声造影与高帧频超声造影表现。图a为常规超声可见胆囊壁上一偏高回声结节（☆处）；图b~d常规超声造影可见息肉呈整体快速强化（Δ处）；图e~h高帧频超声造影可见动脉期造影剂灌注过程中病灶内部单支样血管形态（→处）

图2 腺瘤性息肉常规超声造影与高帧频超声造影表现。图a常规超声可见胆囊壁上一等回声结节（☆处）；图b、c常规超声造影显示病灶整体呈快速增强（Δ处）；图d~h高帧频超声造影可见动脉期造影剂灌注过程中病灶内部分支样血管形态（→处）

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Clinical application of high-frame-rate contrast-enhanced ultrasound in distinguishing gallbladder adenomas from cholesterol polyps

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Clinical application of high-frame-rate contrast-enhanced ultrasound in distinguishing gallbladder adenomas from cholesterol polyps