Lu Man, Yan Brain, Song Jun, Ping Wu, Yue Lin-Xian, Song Bin
Department of Radiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang 610041 Chengdu, Sichuan, China.
J Ultrasound Med. 2014 Apr;33(4):575-83. doi: 10.7863/ultra.33.4.575.
Transabdominal sonography with a gastrointestinal contrast agent has been widely used in China for investigation of digestive disorders. Double-contrast-enhanced sonography combines a gastrointestinal luminal contrast agent with an intravenous contrast agent for imaging of lesions. The purpose of this pilot study was to assess the value of double-contrast-enhanced sonography for preoperative diagnosis of rectal lesions.
We conducted a prospective single-center study using double-contrast-enhanced sonography of rectal lesions. Patients were administered both rectal and intravenous contrast agents, and imaging was performed transabdominally, transanally, and transrectally. Morphologic characteristics and perfusion parameters were compared between histologically proven adenocarcinomas, adenomas, and inflammatory masses. Perfusion parameters were analyzed with time-intensity curves, measuring the contrast arrival time, time to peak, peak intensity, and area under the curve of the lesions and normal rectal tissue.
From January 2009 to September 2012, 420 patients were recruited, with 227 patients meeting inclusion/exclusion criteria and having 232 rectal lesions analyzed (172 rectal adenocarcinomas, 45 adenomas, and 15 inflammatory masses). Adenocarcinomas had variable enhancement patterns. Adenomas were all hypoenhanced in a homogeneous pattern. Inflammatory masses had a hyperenhanced rim with no central enhancement. Time-intensity curve perfusion parameters (arrival time, time to peak, peak intensity, and area under the curve) of rectal adenocarcinomas, adenomas, and inflammatory masses were significantly different compared to normal rectal tissue (P < .05). The differences in the arrival time, peak intensity, and time to peak among the different lesions were also significant (P < .05).
Double-contrast-enhanced sonographic assessment of morphologic enhancement patterns combined with vascularity parameters may help differentiate benign and malignant rectal lesions.
腹部超声联合胃肠道造影剂在中国已广泛应用于消化系统疾病的检查。双对比增强超声将胃肠道腔内造影剂与静脉造影剂联合用于病变成像。本前瞻性研究的目的是评估双对比增强超声在直肠病变术前诊断中的价值。
我们采用直肠病变双对比增强超声进行了一项前瞻性单中心研究。给患者同时使用直肠和静脉造影剂，经腹部、经肛门和经直肠进行成像。比较组织学证实的腺癌、腺瘤和炎性肿块的形态学特征和灌注参数。用时间-强度曲线分析灌注参数，测量病变和正常直肠组织的对比剂到达时间、达峰时间、峰值强度和曲线下面积。
2009年1月至2012年9月，共纳入420例患者，其中227例符合纳入/排除标准，对232个直肠病变进行了分析（172个直肠腺癌、45个腺瘤和15个炎性肿块）。腺癌有多种强化模式。腺瘤均呈均匀低强化。炎性肿块有周边强化，中央无强化。直肠腺癌、腺瘤和炎性肿块的时间-强度曲线灌注参数（到达时间、达峰时间、峰值强度和曲线下面积）与正常直肠组织相比有显著差异（P < 0.05）。不同病变之间的到达时间、峰值强度和达峰时间差异也有统计学意义（P < 0.05）。
双对比增强超声对形态学强化模式和血管参数的评估可能有助于鉴别直肠良性和恶性病变。
