探讨高帧频超声造影（H-CEUS）对最大径为1.0~1.5 cm胆囊腺瘤性息肉和胆固醇性息肉的鉴别诊断价值。

回顾性分析2021年8月至2023年4月解放军总医院第一医学中心76例最大径为1.0~1.5 cm胆囊息肉样病变患者的临床资料，所有患者均于胆囊切除术前行常规超声和H-CEUS检查。采用单因素分析（χ²检验和U检验）比较腺瘤性息肉和胆固醇性息肉患者的临床资料、常规超声图像特征和H-CEUS图像特征的差异。采用二元Logistic回归筛选腺瘤性息肉的独立危险指标。绘制受试者工作特征（ROC）曲线比较常规超声和H-CEUS鉴别腺瘤性息肉的诊断效能。

胆囊腺瘤性息肉23例，胆固醇性息肉53例。常规超声图像上腺瘤性息肉和胆固醇性息肉在息肉的纵横比、数量（多发）、点状强回声（有）和血流信号（有）方面比较［0.8（0.7，1.4） vs 1.8（1.3，2.1），60.87% vs 33.96%，30.43% vs 69.81%，82.61% vs 39.62%］，差异具有统计学意义（Z=-3.892，P＜0.001；χ²=4.764，P=0.029；χ²=10.202，P=0.001；χ²=11.888，P=0.001）。H-CEUS发现开始增强时间（早于胆囊壁）、增强强度（高增强）、血管形态（点状＋线状）、血管性基底宽度和胆囊壁完整性（完整）在腺瘤性息肉和胆固醇性息肉间的差异具有统计学意义［30.43% vs 3.77%，χ²=10.921，P=0.003；86.96% vs 9.43%，χ²=43.668，P＜0.001；21.74% vs 92.45%，χ²=39.697，P＜0.001；3.2（2.5，4.0）mm vs 1.9（1.7，2.1）mm，Z=-5.682，P＜0.001；82.61% vs 98.11%，χ²=6.273，P=0.027］。Logistic回归分析显示，仅息肉的增强强度（OR=2.213，95%CI：1.249~55.890，P=0.029）、血管形态（OR=4.121，95%CI：1.224~13.873，P=0.022）和血管性基底宽度（OR=3.524，95%CI：1.089~11.405，P=0.036）是腺瘤性息肉的独立危险指标。H-CEUS鉴别诊断腺瘤性息肉的敏感度、特异度和准确性分别是91.30%、88.68%和92.11%，曲线下面积为0.918，常规超声鉴别诊断腺瘤性息肉的敏感度、特异度和准确性分别是73.91%、79.25%和77.63%，曲线下面积为0.766，H-CEUS较常规超声具有更高的诊断效能（Z=2.510，P=0.012）。

H-CEUS能准确鉴别最大径为1.0~1.5 cm的腺瘤性息肉和胆固醇性息肉，为息肉患者选择合适治疗方式提供了更准确的超声诊断依据。

To assess the value of high frame rate contrast-enhanced ultrasound (H-CEUS) in the differential diagnosis of gallbladder adenomatous polyps and cholesterol polyps with a maximum size from 1.0 to 1.5 cm.

From August 2021 to April 2023, 76 patients with gallbladder polyp lesions with a maximum size from 1.0 to 1.5 cm in the First Medical Center, Chinese PLA General Hospital were retrospectively analyzed. All patients underwent conventional ultrasound and H-CEUS examination before cholecystectomy. The clinical information and conventional ultrasound and H-CEUS image characteristics were compared between adenomatous polyps and cholesterol polyps by univariate analysis (chi-square test and U test). The independent risk predictors of adenomatous polyps were identified by logistic regression analysis. The diagnostic performance of conventional ultrasound and H-CEUS in distinguishing adenomatous polyps from cholesterol polyps was compared by receiver operating characteristic (ROC) curve analysis.

There were 23 cases of adenomatous polyps and 53 cases of cholesterol polyps. The height/width ratio, number (multiple), hyperechoic spot, and blood flow signal on conventional ultrasound were significantly different between adenomatous polyps and cholesterol polyps [0.8 (0.7, 1.4) vs 1.8 (1.3, 2.1), Z=-3.892, P＜0.001; 60.87% vs 33.96%, χ²=4.764, P=0.029; 30.43% vs 69.81%, χ²=10.202, P=0.001; 82.61% vs 39.62%, χ²=11.888, P=0.001, respectively]. On H-CEUS, enhancement time (prior to the gallbladder wall), enhancement intensity (high enhancement), vascular morphology (petechial+linear), vascular stalk width, and gallbladder wall integrity (intact) of adenomatous polyps were significantly different from those of cholesterol polyps [30.43% vs 3.77%, χ²=10.921, P=0.003; 86.96% vs 9.43%, χ²=43.668, P＜0.001; 21.74% vs 92.45 %, χ²=39.697, P＜0.001; 3.2 (2.5, 4.0) mm vs 1.9 (1.7, 2.1) mm, Z=-5.682, P＜0.001; 82.61% vs 98.11%, χ²=6.273, P=0.027, respectively]. Logistic regression analysis demonstrated that enhancement intensity (odds ratio [OR]=2.213, 95% confidence interval [CI]: 1.249-55.890, P=0.029), vascular morphology (OR=4.121, 95%CI: 1.224-13.873, P=0.022), and vascular stalk width (OR=3.524, 95%CI: 1.089-11.405, P=0.036) were independent risk predictors of adenomatous polyps. The sensitivity, specificity, and accuracy of H-CEUS in distinguishing adenomatous polyps from cholesterol polyps were 91.30%, 88.68%, and 92.11%, respectively, and the area under the curve was 0.918. The sensitivity, specificity, and accuracy of conventional ultrasound in distinguishing adenomatous polyps from cholesterol polyps were 73.91%, 79.25%, and 77.63%, respectively, and the area under the curve was 0.766. H-CEUS had higher diagnostic performance than conventional ultrasound (Z=2.510, P=0.012).

H-CEUS can accurately distinguish adenomatous polyps and cholesterol polyps with a maximum size from 1.0 to 1.5 cm, providing more accurate ultrasound diagnostic evidence for patients with gallbladder polyp lesions to help them choose appropriate treatment means.