超声造影在胆囊局灶性腺肌增生症与胆囊癌鉴别诊断中的应用

Contrast-enhanced ultrasonography in differential diagnosis of focal gallbladder adenomyomatosis and gallbladder cancer.

作者信息

Yuan Hai-Xia, Wang Wen-Ping, Guan Pei-Shan, Lin Le-Wu, Wen Jie-Xian, Yu Qing, Chen Xue-Jun

机构信息

Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China.

Department of Ultrasound, Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian Province, China.

出版信息

Clin Hemorheol Microcirc. 2018;70(2):201-211. doi: 10.3233/CH-180376.

DOI:10.3233/CH-180376

PMID:29630529

Abstract

BACKGROUND

Focal gallbladder adenomyomatosis (ADM) is a common disease that mimics gallbladder cancer (GBC) on ultrasonography.

OBJECTIVE

Here we aim to assess the value of contrast-enhanced ultrasound (CEUS) in differentiating ADM from GBC.

METHODS

Forty-one histopathologically proven focal ADMs and 34 GBCs (≤T2 stage) were enrolled in the study. Lesion location, blood flow signals, contrast pattern and appearance on contrast-enhanced ultrasound (CEUS) were compared respectively.

RESULTS

Lesions were detected in fundus, body, neck at the rates of 61.0% (25/41), 26.8% (11/41) and 12.2% (5/41), respectively, in ADM patients, in comparison to 29.4% (10/34), 32.4% (11/34) and 38.2% (13/34), respectively, in GBC patients (p = 0.009). Blood flow signals were detected in 19.5% (8/41) of cases in ADMs, compared to 58.8% (20/34) in GBCs (p = 0.001). On CEUS, iso-enhancement, hypo-enhancement, intramural anechoic space and intactness of GB wall were detected in 41.5% (17/41), 39.0% (16/41), 56.1% (23/41) and 80.5% (33/41) cases of ADMs, in contrast to 17.6% (6/34), 20.6% (7/34), 20.6% (7/34) and 17.6% (6/34) of GBCs (p = 0.001, p = 0.001, p = 0.002, p < 0.001, respectively). The prior Youden's index were 0.81 based on intactness of GB wall on CEUS.

CONCLUSION

Combined with CEUS helps improve the differential diagnosis accuracy of focal gallbladder ADMs.

摘要

背景

局灶性胆囊腺肌症（ADM）是一种常见疾病，在超声检查中易与胆囊癌（GBC）混淆。

目的

本研究旨在评估超声造影（CEUS）在鉴别ADM与GBC中的价值。

方法

纳入41例经组织病理学证实的局灶性ADM患者和34例GBC患者（≤T2期）。分别比较病变部位、血流信号、造影模式及超声造影（CEUS）表现。

结果

ADM患者中，病变位于胆囊底部、体部、颈部的比例分别为61.0%（25/41）、26.8%（11/41）和12.2%（5/41），而GBC患者中分别为29.4%（10/34）、32.4%（11/34）和38.2%（13/34）（p = 0.009）。ADM患者中19.5%（8/41）的病例检测到血流信号，而GBC患者中为58.8%（20/34）（p = 0.001）。在CEUS上，ADM患者中41.5%（17/41）的病例表现为等增强、39.0%（16/41）为低增强、56.1%（23/41）可见壁内无回声区且胆囊壁完整，而GBC患者中分别为17.6%（6/34）、20.6%（7/34）、20.6%（7/34）和17.6%（6/34）（p分别为0.001、0.001、0.002、<0.001）。基于CEUS上胆囊壁的完整性，先前的约登指数为0.81。