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  本文選題：二維超聲　切入點：三維超聲　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:比較超聲造影及增強CT兩種檢查方法對膽囊良惡性病變的鑒別診斷效能及一致性。方法:對來我院行常規(guī)超聲檢查疑為膽囊占位性病變的患者,同期行超聲造影及增強CT檢查,對資料完整、圖像清晰的48例患者納入研究,觀察分析膽囊良惡性病變的增強水平、增強模式、基底情況、膽囊壁的完整性,并與術(shù)后病理結(jié)果對照,分析兩者的一致性,比較兩者診斷膽囊良惡性病變的敏感性、特異性、準(zhǔn)確性、陽性及陰性預(yù)測值。結(jié)果:48例經(jīng)術(shù)后病理證實,其中膽囊癌19例,包括膽囊腺癌17例和腺瘤癌變2例;膽囊良性病變29例,其中膽囊息肉10例,膽囊腺瘤3例,膽囊腺肌癥8例,膽泥/結(jié)石8例。二維超聲造影:8例常規(guī)超聲未明確定性的膽囊病變(膽泥/結(jié)石)均未見造影劑進入,二維超聲造影診斷檢出率為100%。40例膽囊占位性病變惡性組與良性組比較:膽囊病變的最大徑(3.80±1.66vs1.75±0.73,P0.05)、動脈晚期低增強(15/19vs2/21,78.95%vs9.53%,P0.05)、膽囊壁連續(xù)性(14/19vs21/21,73.68%vs100%,P0.05)、病灶基底情況(18/19vs6/21,94.74%vs28.57%,P0.05)、合并膽泥/結(jié)石(12/19vs2/21,66.16%vs9.52%,P0.05)均有統(tǒng)計學(xué)差異。兩組比較動脈早期高增強、增強模式、時間-強度曲線1分鐘曲線下面積無統(tǒng)計學(xué)差異。二維超聲造影診斷膽囊良惡性病變的敏感性、特異性、準(zhǔn)確性、陽性及陰性預(yù)測值分別為94.71%、90.48%、92.50%、90.00%、95.0%;Kappa值為0.850,超聲造影與術(shù)后病理診斷結(jié)果一致性良好。三維超聲造影:8例常規(guī)超聲未明確定性的膽囊病變(膽泥/結(jié)石)均未見造影劑進入,三維超聲造影診斷檢出率為100%。40例膽囊占位性病灶惡性組與良性組比較:病灶增強形態(tài)、病灶模式、基底情況以及與囊壁的分界之間均有統(tǒng)計學(xué)差異(P0.05)。三維超聲造影診斷敏感性、特異性、準(zhǔn)確性、陽性及陰性預(yù)測值分別為94.74%、95.25%、95.0%、94.74%、94.74%。增強CT:8例常規(guī)超聲未明確定性的膽囊病變(膽泥/結(jié)石)均始終未見強化,增強CT診斷檢出率為100%。40例膽囊病灶惡性組與良性組比較:病灶增強晚期低增強、增強模式、基底情況以及囊壁連續(xù)性中斷均有統(tǒng)計學(xué)差異(P0.05),增強CT診斷膽囊良惡性病變的敏感性、特異性、準(zhǔn)確性、陽性及陰性預(yù)測值分別為92.31%、94.87%、94.23%、94.44%、90.91%。與術(shù)后病理診斷結(jié)果比較:Kappa值為0.849,說明增強CT與術(shù)后病理診斷結(jié)果有較好的一致性。超聲造影與增強CT比較:超聲造影與增強CT對膽囊惡性病變圖像特征分析比較,增強水平(早期高增強,晚期低增強)、增強模式、基底情況、膽壁完整性、合并膽泥/結(jié)石、合并局部浸潤及合并遠處轉(zhuǎn)移均無統(tǒng)計學(xué)差異(P0.05)。超聲造影與增強CT對膽囊良性病變圖像特征分析比較,增強水平(早期高增強,晚期低增強)、增強模式、基底情況、膽壁完整性均無統(tǒng)計學(xué)差異(P0.05)。超聲造影診斷膽囊病變的敏感性、特異性、準(zhǔn)確性、陽性預(yù)測值及陰性預(yù)測值分別為94.74%、90.48%、92.50%、90.0%、95.0%。增強CT診斷膽囊病變的敏感性、特異性及準(zhǔn)確性分別為89.47%、95.24%、92.50%、94.44%、90.91%,經(jīng)配對卡方檢驗無統(tǒng)計學(xué)差異。結(jié)論:(1)超聲造影與增強CT對膽囊良惡性病變增強特點對比分析一致性良好。(2)超聲造影與增強CT對膽囊病變均具有較高診斷效能,二者均為膽囊癌的TNM分期及臨床治療提供全面的影像學(xué)資料。
[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.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R735.8;R730.44

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