Watanabe Y, Goto H, Naitoh Y, Hirooka Y, Itoh A, Taki T, Hayakawa S, Hayakawa T
Second Department of Internal Medicine, Nagoya University School of Medicine, Japan.
J Ultrasound Med. 1998 Jan;17(1):33-9. doi: 10.7863/jum.1998.17.1.33.
This study was designed to compare intraductal ultrasonography of the gallbladder wall with histopathologic findings and to assess the clinical usefulness of this imaging method in gallbladder disease. Thirty-one gallbladder specimens were examined by intraductal ultrasonography retrospectively. The gallbladder is composed of three layers: an innermost hyperechoic layer, a middle hypoechoic layer, and an outermost hyperechoic layer. The second layer on ultrasonograms corresponds to the muscle layer plus the fibrous tissue of the superficial perimuscular connective tissue layer. In cases in which the thickness of the second layer was 500 microns or less, little fibrous tissue was seen and the second layer was approximately identical to the muscle layer on sonograms. Clinical study was performed on 22 gallbladders. The use of a guidewire through the papilla facilitated intraductal ultrasonographic examination. The intraductal sonographic probe could be inserted into the gallbladder fundus in 13 of 22 cases. In nine unsuccessful cases, technical difficulties were as follows: sharply angulated gallbladder (four cases), stenosis of the gallbladder (two cases), difficulty in transmitting power in the correct direction (three cases). With regard to the area visualized in 13 successful cases, in three cases the area visualized was 100%, in seven cases it was 75%, and three cases it was 50%. Intraductal ultrasonographic images could be obtained in 83.3% (10 of 12) of elevated lesions of the gallbladder. The indications for intraductal ultrasonography will be cases in which an abnormality was detected by transabdominal ultrasonography or other modalities in which the physician does not know whether or not to operate. In conclusion, we defined the intraductal sonographic images of gallbladder wall and clarified the clinical indications for use of this imaging method.
本研究旨在比较胆囊壁的导管内超声检查结果与组织病理学发现，并评估这种成像方法在胆囊疾病中的临床应用价值。对31个胆囊标本进行了回顾性导管内超声检查。胆囊由三层组成：最内层的高回声层、中间的低回声层和最外层的高回声层。超声图像上的第二层对应于肌层加上浅表肌周结缔组织层的纤维组织。在第二层厚度为500微米或更小的病例中，几乎看不到纤维组织，第二层在超声图像上与肌层大致相同。对22个胆囊进行了临床研究。通过乳头插入导丝有助于导管内超声检查。22例中有13例可将导管内超声探头插入胆囊底部。在9例未成功的病例中，技术困难如下：胆囊角度尖锐（4例）、胆囊狭窄（2例）、难以将能量沿正确方向传输（3例）。关于13例成功病例中可视化的区域，3例可视化区域为100%，7例为75%，3例为50%。在83.3%（12例中的10例）的胆囊隆起性病变中可获得导管内超声图像。导管内超声检查的适应证将是经腹部超声或其他检查发现异常但医生不知是否需要手术的病例。总之，我们明确了胆囊壁的导管内超声图像，并阐明了这种成像方法的临床应用指征。
