超声造影与增强CT在鉴别诊断胆囊良恶性病变中的应用价值

目的对比分析胆囊良恶性病变超声造影（CEUS）及增强CT（CECT）的图像特征，探讨二者在胆囊良恶性病变中的诊断价值。 方法选取2010年1月至2017年9月在陆军军医大学第一附属医院就诊的经病理证实的86例胆囊病变患者，术前CEUS与CECT的图像特征以及术前诊断结果进行对比分析。胆囊病变CEUS与CECT的增强模式比较以及单用CEUS或CECT与联合运用的诊断准确性的比较采用McNemer检验，CEUS胆囊良恶性病变由高增强转变为低增强的时间比较用t检验。 结果胆囊良恶性病变CEUS与CECT的增强模式类似。动脉期，良恶性病变CEUS与CECT均以高增强为主，其中，恶性病变分别为83.8%（57/68）、85.3%（58/68），差异无统计学意义（P=1.000），良性病变分别为100%（18/18）、94.4%%（17/18）。恶性病变CEUS与CECT在增强晚期或延迟期表现为低增强者分别为86.8%（59/68）、85.3%（58/68），差异无统计学意义（P=0.500）,良性病变CEUS与CECT在增强晚期或延迟期表现为低增强者分别为83.3%（15/18）、77.8%（14/18）。良恶性病变CEUS转变为低增强的时间比较，差异有统计学意义（53.9±10.0）s vs（35.50±6.72）s，t=6.729，P<0.001）]。单用CEUS其诊断胆囊恶性病变的敏感度、特异度及准确性分别为77.9%（53/68）、77.8%（14/18）、77.9%（67/86）；单用CECT其诊断敏感度、特异度及准确性分别为75%（51/68）、55.6%（10/18）、70.9%（61/86）；联合应用两种检查方法的敏感度、特异度及准确性分别为83.8%（57/68）、55.6%（10/18）、77.9%（67/86）；CEUS与CECT联合应用对胆囊恶性病变诊断准确性高于单用CECT。 结论CEUS与CECT结合有助于提高胆囊恶性病变诊断准确性，为胆囊良恶性病变的鉴别诊断提供更多有价值的信息。

The value of contrast-enhanced ultrasound and contrast-enhanced CT in the differential diagnosis of benign and malignant gallbladder diseases

ObjectiveTo comparatively analyze the image characteristic of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT), and explore the diagnostic value of the two methods in benign and malignant lesions of gallbladder. Methodscomparative analysis the image characteristic of CEUS and CECT, the preoperative diagnostic results of 86 cases of gallbladder diseases were confirmed by pathology. ResultsThe enhancement patterns of CEUS and CECT in benign and malignant lesions of gallbladder are similar. The sensitivity, specificity and accuracy of CEUS were 77.9% (53/68), 77.8% (14/18), 77.9% (67/86), respectively. The sensitivity, specificity and accuracy of CECT were 75% (51/68), 55.6% (10/18), 70.9% (61/86), respectively. The sensitivity, specificity and accuracy of the combination of CEUS and CECT were 83.8% (57/68), 55.6% (10/18), 77.9% (67/86), respectively. The accuracy of the combination of CEUS and CECT was higher than that of CECT in the diagnosis of malignant gallbladder lesions (53.9±10.00) s vs (35.50±6.72) s], the differences were statistically significant (t=6.729, P<0.001). ConclusionsThe enhancement patterns of CEUS and CECT in benign and malignant gallbladder lesions are similar. The combination of CEUS and CECT is helpful for improving the diagnostic accuracy of malignant gallbladder lesions. CEUS and CECT could corroborate and complement each other, and provide more valuable information for the differential diagnosis of benign and malignant gallbladder lesions.