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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (08) : 807 -812. doi: 10.3877/cma.j.issn.1672-6448.2022.08.014

腹部超声影像学

常规超声图像特征对胆囊息肉样病变的鉴别诊断价值
朱连华1, 韩鹏1, 姜波1, 李楠1, 焦子育1, 唐文博2, 费翔1,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心超声科
    2. 100853　北京，解放军总医院肝胆外科
  • 收稿日期:2020-12-28 出版日期:2022-08-01
  • 通信作者: 费翔

Value of conventional ultrasound image characteristics in differential diagnosis of gallbladder polyp lesions

Lianhua Zhu1, Peng Han1, Bo Jiang1, Nan Li1, Ziyu Jiao1, Wenbo Tang2, Xiang Fei1,†()   

  1. 1. Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
    2. Department of Hepatobiliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2020-12-28 Published:2022-08-01
  • Corresponding author: Xiang Fei
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引用本文：

朱连华, 韩鹏, 姜波, 李楠, 焦子育, 唐文博, 费翔. 常规超声图像特征对胆囊息肉样病变的鉴别诊断价值[J/OL]. 中华医学超声杂志（电子版）, 2022, 19(08): 807-812.

Lianhua Zhu, Peng Han, Bo Jiang, Nan Li, Ziyu Jiao, Wenbo Tang, Xiang Fei. Value of conventional ultrasound image characteristics in differential diagnosis of gallbladder polyp lesions[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(08): 807-812.

目的

探讨常规超声对最大径1.0~1.5 cm的胆固醇性息肉与胆囊腺瘤的鉴别诊断价值。

方法

回顾性分析2019年5月至2020年10月解放军总医院第一医学中心87例最大径为1.0~1.5 cm的胆囊息肉样病变患者的临床资料，所有患者均行常规超声检查，并取得术后病理检查。根据病理结果将其分为胆固醇性息肉组和胆囊腺瘤组。比较2组患者的年龄、性别，胆囊息肉样病变的最大径、纵横比、基底部宽度、息肉部位、回声特征、回声均匀性、边界、数量以及是否存在点状强回声、血流信号和结石。应用Logistic回归分析胆囊腺瘤的独立危险因素，采用ROC曲线评价不同超声特征诊断胆囊腺瘤的效能。

结果

87例患者中胆固醇性息肉65例，胆囊腺瘤22例。胆固醇性息肉组与胆囊腺瘤组的病变最大径、纵横比、病变存在点状强回声占比、存在血流信号占比以及存在结石占比进行比较［1.2（1.1，1.3）cm vs 1.2（1.1，1.4）cm，1.0（0.7，1.5）vs 0.6（0.5，0.7），73.85% vs 22.73%，9.23% vs 54.55%，3.08% vs 18.18%］，差异均有统计学意义（Z=-2.048、-3.396，χ2=18.041、20.569、5.841，P均＜0.05）。Logistic回归分析显示，仅胆囊息肉样病变的纵横比＜0.8、无点状强回声和存在血流信号是胆囊腺瘤的独立危险因素（P均＜0.05）。结合上述独立危险因素，常规超声诊断最大径为1.0~1.5 cm胆囊腺瘤的敏感度、特异度和准确性分别为86.36%、90.77%和89.66%，曲线下面积为0.906，其大于单一超声特征的ROC曲线下面积（P＜0.05）。

结论

常规超声观察胆囊息肉样病变纵横比、是否存在点状强回声和血流信号对于最大径为1.0~1.5 cm的胆固醇性息肉与胆囊腺瘤的鉴别诊断具有较高的应用价值，可为胆囊息肉样病变患者治疗方案的选择提供可靠的诊断信息。

关键词: 胆囊, 息肉, 腺瘤, 超声检查
Objective

To assess the value of conventional ultrasound in the differential diagnosis of cholesterol polyp lesions and gallbladder adenomas with the maximum size from 1.0 to 1.5 cm.

Methods

From May 2019 to October 2020, the clinical data of 87 patients with gallbladder polyp lesions with the maximum size from 1.0 to 1.5 cm at the First Medical Center, Chinese PLA General Hospital were retrospectively analyzed. All patients underwent conventional ultrasound examination and pathological examination. According to the pathological findings, all patients were divided into either a cholesterol polyp lesion group or a gallbladder adenoma group. Patient age, gender, maximum size, anteroposterior/transverse diameter (A/T) ratio, stalk width, location, echogenicity, echogenicity uniformity, boundary, number, hyperechoic spot, blood flow signal, and gallstones were compared between the two groups. Logistic regression analysis was performed to identify the independent risk factors for gallbladder adenomas. ROC curve was used to evaluate the performance of conventional ultrasound in the diagnosis of gallbladder adenomas with the maximum size from 1.0 to 1.5 cm.

Results

Among the 87 patients with gallbladder polyp lesions, 65 had cholesterol polyp lesions and 22 had gallbladder adenomas. The maximum size, A/T ratio, percentage of lesions with hyperechoic spot, percentage of lesions with blood flow signal, and percentage of lesions with gallstones differed significantly between the cholesterol polyp lesion group and gallbladder adenoma group [ 1.2 (1.1, 1.3) cm vs 1.2 (1.1, 1.4) cm, Z=-2.048, P＜0.05; 1.0 (0.7, 1.5) vs 0.6 (0.5, 0.7), Z=-3.396, P＜0.05; 73.85% vs 22.73%, χ2=18.041, P＜0.05; 9.23% vs 54.55%, χ2=20.569, P＜0.05; 3.08% vs 18.18%, χ2=5.841, P＜0.05]. Logistic regression analysis showed that only the A/T ratio less than 0.8, absence of hyperechoic spot, and presence of blood flow signal were independent risk factors for gallbladder adenomas (P＜0.05). When combining all independent risk factors, the sensitivity, specificity, and accuracy of conventional ultrasound in diagnosing gallbladder adenomas with the maximum size from 1.0 to 1.5 cm were 86.36%, 90.77%, and 89.66%, respectively, and the area under the ROC curve was 0.906. The area under the ROC curve of the risk factors combined was larger than that of either ultrasound feature alone (P＜0.05).

Conclusion

A/T ratio, hyperechoic spot, and blood flow signal of gallbladder polyp lesions on conventional ultrasound images have high application value in the differential diagnosis of cholesterol polyp lesions and gallbladder adenomas with the maximum size from 1.0 to 1.5 cm, which provides reliable diagnostic information for the choice of treatment for patients with gallbladder polyp lesions.

Key words: Gallbladder, Polyps, Adenoma, Ultrasonography
表1 胆固醇性息肉患者与胆囊腺瘤患者的一般资料和超声图像特征比较
一般资料及超声特征 胆固醇性息肉（n=65） 胆囊腺瘤（n=22） 统计值 P值
年龄［岁，M（P25，P75）］ 38（29，45） 45（27，53） Z=0.840 0.401
性别［例（%）］ χ2=0.870 0.351
男 37（56.92） 10（45.45）
女 28（43.08） 12（54.55）
最大径［cm，M（P25，P75）］ 1.2（1.1，1.3） 1.2（1.1，1.4） Z=-2.048 0.041
纵横比［M（P25，P75）］ 1.0（0.7，1.5） 0.6（0.5，0.7） Z=-3.396 0.001
基底部宽度［mm，M（P25，P75）］ 4.0（3.0，5.0） 4.0（3.0，6.0） Z=-1.227 0.220
部位［例（%）］ χ2=1.495 0.432
颈部 7（10.77） 1（4.55）
体部 47（72.31） 15（68.18）
底部 11（16.92） 6（27.27）
回声［例（%）］ χ2=3.674 0.124
高回声 54（83.08） 15（68.18）
等回声 10（15.38） 5（22.73）
低回声 1（1.54） 2（9.09）
回声均匀性［例（%）］ χ2=1.673 0.196
均匀 34（52.31） 8（36.36）
不均匀 31（47.69） 14（63.64）
边界［例（%）］ χ2=1.242 0.569
光滑 40（61.54） 14（63.64）
分叶 15（23.08） 3（13.64）
颗粒 10（15.38） 5（22.73）
数量［例（%）］ χ2=2.510 0.113
单发 23（35.38） 12（54.55）
多发 42（64.62） 10（45.45）
点状强回声［例（%）］ χ2=18.041 ＜0.001
有 48（73.85） 5（22.73）
无 17（26.15） 17（77.27）
血流信号［例（%）］ χ2=20.569 ＜0.001
有 6（9.23） 12（54.55）
无 59（90.77） 10（45.45）
结石［例（%）］ χ2=5.841 0.034
有 2（3.08） 4（18.18）
无 63（96.92） 18（81.82）
表2 Logistic回归分析胆囊腺瘤的独立危险因素
参数 相关系数 标准误 OR值 95%CI P值
纵横比≥0.8 -2.846 1.077 0.058 0.007~0.479 0.008
有点状强回声 -2.824 0.770 0.013 0.059~0.013 ＜0.001
有血流信号 2.458 0.829 11.686 2.301~59.343 0.003
图1 胆固醇性息肉常规超声图像。图a为灰阶超声示胆囊壁上一偏高回声结节（星号所示），纵横比为1.8，内可见点状强回声（箭头所示）；图b为彩色多普勒超声示其内未见血流信号（星号所示为结节）
图2 胆囊腺瘤常规超声图像。图a为灰阶超声示胆囊壁上一偏低回声结节（星号所示），纵横比为0.6，内未见点状强回声；图b为彩色多普勒超声示其内可见血流信号（星号所示为结节）
图3 超声特征鉴别诊断胆囊息肉样病变的ROC曲线
表3 超声特征诊断胆囊腺瘤的ROC曲线分析
超声特征 最佳截断值 敏感度（%） 特异度（%） 准确性（%） ROC曲线下面积
最大径 1.3 cm 40.91 84.62 73.56 0.643
纵横比 0.8 77.27 67.69 70.11 0.742
点状强回声 - 77.27 73.85 74.71 0.756
血流信号 - 54.55 90.77 81.61 0.727
结石 - 18.18 96.92 77.01 0.576
综合危险因素 1 86.36 90.77 89.66 0.906
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