胆囊良恶性病变超声造影与增强CT的对比研究

发布时间：2018-03-18 12:53

本文选题：二维超声　切入点：三维超声　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:比较超声造影及增强CT两种检查方法对胆囊良恶性病变的鉴别诊断效能及一致性。方法:对来我院行常规超声检查疑为胆囊占位性病变的患者,同期行超声造影及增强CT检查,对资料完整、图像清晰的48例患者纳入研究,观察分析胆囊良恶性病变的增强水平、增强模式、基底情况、胆囊壁的完整性,并与术后病理结果对照,分析两者的一致性,比较两者诊断胆囊良恶性病变的敏感性、特异性、准确性、阳性及阴性预测值。结果:48例经术后病理证实,其中胆囊癌19例,包括胆囊腺癌17例和腺瘤癌变2例;胆囊良性病变29例,其中胆囊息肉10例,胆囊腺瘤3例,胆囊腺肌症8例,胆泥/结石8例。二维超声造影:8例常规超声未明确定性的胆囊病变(胆泥/结石)均未见造影剂进入,二维超声造影诊断检出率为100%。40例胆囊占位性病变恶性组与良性组比较:胆囊病变的最大径(3.80±1.66vs1.75±0.73,P0.05)、动脉晚期低增强(15/19vs2/21,78.95%vs9.53%,P0.05)、胆囊壁连续性(14/19vs21/21,73.68%vs100%,P0.05)、病灶基底情况(18/19vs6/21,94.74%vs28.57%,P0.05)、合并胆泥/结石(12/19vs2/21,66.16%vs9.52%,P0.05)均有统计学差异。两组比较动脉早期高增强、增强模式、时间-强度曲线1分钟曲线下面积无统计学差异。二维超声造影诊断胆囊良恶性病变的敏感性、特异性、准确性、阳性及阴性预测值分别为94.71%、90.48%、92.50%、90.00%、95.0%;Kappa值为0.850,超声造影与术后病理诊断结果一致性良好。三维超声造影:8例常规超声未明确定性的胆囊病变(胆泥/结石)均未见造影剂进入,三维超声造影诊断检出率为100%。40例胆囊占位性病灶恶性组与良性组比较:病灶增强形态、病灶模式、基底情况以及与囊壁的分界之间均有统计学差异(P0.05)。三维超声造影诊断敏感性、特异性、准确性、阳性及阴性预测值分别为94.74%、95.25%、95.0%、94.74%、94.74%。增强CT:8例常规超声未明确定性的胆囊病变(胆泥/结石)均始终未见强化,增强CT诊断检出率为100%。40例胆囊病灶恶性组与良性组比较:病灶增强晚期低增强、增强模式、基底情况以及囊壁连续性中断均有统计学差异(P0.05),增强CT诊断胆囊良恶性病变的敏感性、特异性、准确性、阳性及阴性预测值分别为92.31%、94.87%、94.23%、94.44%、90.91%。与术后病理诊断结果比较:Kappa值为0.849,说明增强CT与术后病理诊断结果有较好的一致性。超声造影与增强CT比较:超声造影与增强CT对胆囊恶性病变图像特征分析比较,增强水平(早期高增强,晚期低增强)、增强模式、基底情况、胆壁完整性、合并胆泥/结石、合并局部浸润及合并远处转移均无统计学差异(P0.05)。超声造影与增强CT对胆囊良性病变图像特征分析比较,增强水平(早期高增强,晚期低增强)、增强模式、基底情况、胆壁完整性均无统计学差异(P0.05)。超声造影诊断胆囊病变的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为94.74%、90.48%、92.50%、90.0%、95.0%。增强CT诊断胆囊病变的敏感性、特异性及准确性分别为89.47%、95.24%、92.50%、94.44%、90.91%,经配对卡方检验无统计学差异。结论:(1)超声造影与增强CT对胆囊良恶性病变增强特点对比分析一致性良好。(2)超声造影与增强CT对胆囊病变均具有较高诊断效能,二者均为胆囊癌的TNM分期及临床治疗提供全面的影像学资料。
[Abstract]:Objective: To compare efficacy and consistency of differential diagnosis of ultrasonic angiography and CT of two kinds of examination methods for benign and malignant lesions of the gallbladder. Methods: our hospital underwent ultrasonic examination of suspected gallbladder lesions in patients underwent ultrasonic angiography and CT examination, to complete data, 48 patients were included in the study of image clearly, the observation and analysis of benign and malignant lesions of the gallbladder enhancement level, enhancement pattern, substrate, integrity of the gallbladder wall, and compared with the pathological results, analysis of the consistency of the two, sensitive, compare the diagnosis of gallbladder benign and malignant lesions of the specificity, accuracy, positive and negative predictive value. Results: 48 cases were confirmed by surgery and pathology, including 19 cases of gallbladder carcinoma, including 17 cases of gallbladder carcinoma and 2 cases of gallbladder adenoma; 29 cases of benign lesions, including 10 cases of gallbladder polyps, 3 cases of gallbladder adenoma, 8 cases of adenomyomatosis of gallbladder, biliary sludge / calculi in 8 cases. Two dimensional ultrasound made Shadow: gallbladder lesions in 8 cases of conventional ultrasound was uncertain (the biliary sludge / stone) showed no contrast agent into the two-dimensional ultrasound diagnosis, the detection rate of 100%.40 cases of gallbladder lesions of malignant group and benign group: lesions of gallbladder diameter (3.80 + 1.66vs1.75 + 0.73, P0.05), low (late arterial enhancement 15/19vs2/21,78.95%vs9.53%, P0.05), gallbladder wall continuity (14/19vs21/21,73.68%vs100%, P0.05), the lesion of basal (18/19vs6/21,94.74%vs28.57%, P0.05), the situation with biliary sludge / stones (12/19vs2/21,66.16%vs9.52%, P0.05) were statistically different between the two groups. The early arterial enhancement, enhancement pattern, area of no significant difference between the time intensity curve under the curve of 1 minutes. The sensitivity of two-dimensional ultrasonography in the diagnosis of gallbladder benign and malignant lesions of the specificity, accuracy, positive and negative predictive value were 94.71%, 90.48%, 92.50%, 90%, 95%; Kappa = 0.850, ultrasound The contrast with the postoperative pathological diagnosis results are consistent. Three dimensional ultrasound angiography: gallbladder lesions in 8 cases of conventional ultrasound was uncertain (the biliary sludge / stone) showed no contrast agent into three-dimensional ultrasonography in the diagnosis of the detection rate of 100%.40 cases of cystic lesions of malignant group and benign group compared: enhanced lesion morphology, lesion pattern, there were statistically significant differences between the boundary between the substrate and the cyst wall (P0.05). Three dimensional ultrasound diagnostic sensitivity, specificity, accuracy, positive and negative predictive value were 94.74%, 95.25%, 95%, 94.74%, 94.74%. enhanced CT:8 cases of conventional ultrasound was uncertain in gallbladder lesions (biliary stones were always seen /) enhancement, enhanced CT diagnosis rate for 100%.40 patients with gallbladder malignant lesions compared with the benign group: enhanced lesions with low enhancement, enhancement pattern, base and wall of fault were statistically significant (P0.05) And enhance the sensitivity of CT in the diagnosis of gallbladder benign and malignant lesions, specificity, accuracy, positive and negative predictive value were 92.31%, 94.87%, 94.23%, 94.44%, compared with the postoperative pathological diagnosis of 90.91%.: Kappa value is 0.849, enhanced CT and postoperative pathological diagnosis results have a good consistent. With contrast-enhanced ultrasound enhanced CT comparison: comparison of contrast-enhanced ultrasonography and contrast-enhanced CT analysis of malignant gallbladder lesions image features, the enhancement level (early high enhancement, advanced low, enhanced mode enhancement), basal, gallbladder wall integrity, combined with biliary sludge / stone, combined with local infiltration and metastasis were not statistically significant (P0.05). Contrast enhanced ultrasound with the enhancement of CT comparative analysis of gallbladder benign lesions (image features, enhance the level of early high enhancement, advanced low, enhanced mode enhancement), basement, there was no significant difference of biliary wall integrity (P0.05). The sensitivity of ultrasonography in the diagnosis of gallbladder diseases Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 94.74%, 90.48%, 92.50%, 90%, 95.0%. CT in the diagnosis of gallbladder lesions enhanced sensitivity, specificity and accuracy were 89.47%, 95.24%, 92.50%, 94.44%, 90.91%, the chi square test showed no significant difference. Conclusion: (1) ultrasound with contrast enhanced CT in benign and malignant lesions of the gallbladder enhance the comparative study of characteristics of good consistency. (2) of contrast-enhanced ultrasonography and contrast-enhanced CT of gallbladder diseases have high diagnostic efficiency, two are staging and clinical treatment of gallbladder carcinoma TNM provide comprehensive imaging data.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R735.8;R730.44

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