Kim Jung Hoon, Lee Jae Young, Baek Jee Hyun, Eun Hyo Won, Kim Young Jae, Han Joon Koo, Choi Byung Ihn
1 Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-no, Chongno-gu, Seoul 110-744, Korea.
AJR Am J Roentgenol. 2015 Feb;204(2):W150-9. doi: 10.2214/AJR.13.11992.
OBJECTIVE. The purposes of this study were to compare staging accuracy of high-resolution sonography (HRUS) with combined low- and high-MHz transducers with that of conventional sonography for gallbladder cancer and to investigate the differences in the imaging findings of neoplastic and nonneoplastic gallbladder polyps. MATERIALS AND METHODS. Our study included 37 surgically proven gallbladder cancer (T1a = 7, T1b = 2, T2 = 22, T3 = 6), including 15 malignant neoplastic polyps and 73 surgically proven polyps (neoplastic = 31, nonneoplastic = 42) that underwent HRUS and conventional transabdominal sonography. Two radiologists assessed T-category and predefined polyp findings on HRUS and conventional transabdominal sonography. Statistical analyses were performed using chi-square and McNemar tests. RESULTS. The diagnostic accuracy for the T category was T1a = 92-95%, T1b = 89-95%, T2 = 78-86%, and T3 = 84-89%, all with good agreement (κ = 0.642) using HRUS. The diagnostic accuracy for differentiating T1 from T2 or greater than T2 was 92% and 89% on HRUS and 65% and 70% with conventional transabdominal sonography. Statistically common findings for neoplastic polyps included size greater than 1 cm, single lobular surface, vascular core, hypoechoic polyp, and hypoechoic foci (p < 0.05). The value of HRUS in the differential diagnosis of a gallbladder polyp was more clearly depicted internal echo foci than conventional transabdominal sonography (39 vs 21). A polyp size greater than 1 cm was independently associated with a neoplastic polyp (odds ratio = 7.5, p = 0.02). The AUC of a polyp size greater than 1 cm was 0.877. The sensitivity and specificity were 66.67% and 89.13%, respectively. CONCLUSION. HRUS is a simple method that enables accurate T categorization of gallbladder carcinoma. It provides high-resolution images of gallbladder polyps and may have a role in stratifying the risk for malignancy.
目的。本研究的目的是比较采用高低频组合探头的高分辨率超声（HRUS）与传统超声对胆囊癌的分期准确性，并研究肿瘤性和非肿瘤性胆囊息肉的影像学表现差异。材料与方法。我们的研究纳入了37例经手术证实的胆囊癌（T1a = 7例，T1b = 2例，T2 = 22例，T3 = 6例），包括15例恶性肿瘤性息肉，以及73例经手术证实的息肉（肿瘤性 = 31例，非肿瘤性 = 42例），这些患者均接受了HRUS和传统经腹超声检查。两名放射科医生对HRUS和传统经腹超声检查的T分期及预设的息肉表现进行评估。采用卡方检验和McNemar检验进行统计分析。结果。使用HRUS时，T分期的诊断准确率为T1a = 92 - 95%，T1b = 89 - 95%，T2 = 78 - 86%，T3 = 84 - 89%，一致性均良好（κ = 0.642）。HRUS鉴别T1与T2或大于T2的诊断准确率分别为92%和89%，而传统经腹超声分别为65%和70%。肿瘤性息肉在统计学上的常见表现包括大小大于1 cm、单叶表面、血管核心、低回声息肉及低回声灶（p < 0.05）。与传统经腹超声相比，HRUS在胆囊息肉鉴别诊断中更能清晰显示内部回声灶（39个对21个）。息肉大小大于1 cm与肿瘤性息肉独立相关（比值比 = 7.5，p = 0.02）。息肉大小大于1 cm的曲线下面积为0.877。敏感性和特异性分别为66.67%和89.13%。结论。HRUS是一种能对胆囊癌进行准确T分期的简单方法。它能提供胆囊息肉的高分辨率图像，可能在恶性风险分层中发挥作用。
