超声造影与多期增强 CT 对胆囊病变的评估比较。

Contrast enhanced ultrasound versus multiphasic contrast enhanced computed tomography in evaluation of gallbladder lesions.

机构信息

Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Departments of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

出版信息

Abdom Radiol (NY). 2022 Feb;47(2):566-575. doi: 10.1007/s00261-021-03364-6. Epub 2021 Dec 7.

DOI:10.1007/s00261-021-03364-6

PMID:34874479

Abstract

AIM

To compare the diagnostic performance of contrast enhanced ultrasound (CEUS) and multiphasic contrast enhanced computed tomography (CECT) in differentiating benign and malignant gallbladder (GB) lesions.

METHODS

This prospective ethical review board approved study comprised consecutive patients with GB lesions who underwent CEUS and multiphasic CECT at a tertiary care referral center. The enhancement patterns at CEUS and CT were compared. The quantitative CEUS parameters including arrival time (AT), AT in liver, time to peak enhancement, and washout time (WT) were assessed. The diagnostic performance of CEUS and CT features was calculated using receiver operating characteristic analysis. A subgroup analysis was performed for patients with GB wall thickening. Multivariate analysis was performed to identify features significantly associated with malignancy.

RESULTS

Over the study period, 30 patients (mean age, 52.8 ± 12.2 years, 17 females) with GB lesions were evaluated. Benign and malignant diseases were present in 13 and 17 patients, respectively. There was excellent agreement between CEUS and CT findings. Among the quantitative CEUS features, only WT was significantly associated with malignancy in the overall group (p < 0.001) and wall thickening subgroup (p = 0.007). WT within 53.5 s and 51.5 s had sensitivity of 88.2% and 81.8% and specificity of 84.5% and 100% in diagnosing malignant lesions in the overall group (AUC 0.900) and the wall thickening subgroup (area under curve, AUC 0.927), respectively. At multivariate analysis, features that were significantly associated with malignant lesions in the overall group were disruption of GB wall (CEUS), intralesional non-enhancing areas (CEUS), liver involvement (CEUS or CT), and arterial phase hyperenhancement (CT) in the overall group and disruption of GB wall (CEUS), WT (CEUS), and liver involvement (CEUS or CT) in the wall thickening subgroup.

CONCLUSION

CEUS is a useful adjunct to CT in evaluation of GB lesions. Its utilization in patients with GB wall thickening may improve detection of malignancy.

摘要

目的

比较超声造影（CEUS）和多期增强 CT（CECT）在鉴别胆囊（GB）良恶性病变中的诊断性能。

方法

本前瞻性伦理审查委员会批准的研究纳入了在三级转诊中心行 CEUS 和多期 CECT 的连续胆囊病变患者。比较 CEUS 和 CT 的增强模式。评估超声造影的定量参数包括到达时间（AT）、肝内 AT、达峰时间和洗脱时间（WT）。采用受试者工作特征曲线分析计算 CEUS 和 CT 特征的诊断性能。对胆囊壁增厚的患者进行亚组分析。采用多变量分析确定与恶性肿瘤显著相关的特征。

结果

在研究期间，对 30 例（平均年龄 52.8±12.2 岁，女性 17 例）胆囊病变患者进行了评估。良性和恶性疾病分别为 13 例和 17 例。CEUS 和 CT 检查结果之间具有极好的一致性。在定量超声造影特征中，只有 WT 在整体组（p<0.001）和壁增厚亚组（p=0.007）中与恶性肿瘤显著相关。WT 为 53.5s 和 51.5s 时，整体组（曲线下面积，AUC 0.900）和壁增厚亚组（AUC 0.927）诊断恶性病变的敏感度分别为 88.2%和 81.8%，特异度分别为 84.5%和 100%。在多变量分析中，整体组中与恶性病变显著相关的特征为胆囊壁破坏（CEUS）、病灶内无增强区（CEUS）、肝累及（CEUS 或 CT）和动脉期强化（CT），壁增厚亚组中与恶性病变显著相关的特征为胆囊壁破坏（CEUS）、WT（CEUS）和肝累及（CEUS 或 CT）。