Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Gallbladder Wall Thickening
Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Gallbladder Wall Thickening
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DOI：
10.1007/s10620-014-3115-5
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发表时间：
2014-08-01
影响因子：
3.1
通讯作者：
Tajiri, Hisao
中科院分区：
文献类型：
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作者：
Imazu, Hiroo;Mori, Naoki;Tajiri, Hisao
胆囊癌与良性胆囊壁增厚的鉴别具有挑战性。最近引进的第二代超声造影剂使EUS的对比谐波成像成为可能。本研究的目的是评价对比增强谐波EUS（CH-EUS）在鉴别诊断GB壁增厚中的应用。常规谐波EUS（H-EUS）观察病灶后，静脉注射Sonazoid 0.015ml/kg，行CH-EUS。3名具有不同水平EUS经验的评审员（评审员A：经验丰富的内镜超声医师，B：EUS实习生，C：具有经腹超声专业知识但无EUS经验的经验丰富的胃肠病学家）对H-EUS和CH-EUS记录视频的结果设盲。比较了H-EUS和CH-EUS对恶性胆囊壁增厚的诊断准确性，根据手术组织学最终诊断为胆囊癌16例，胆囊炎11例，腺肌瘤病6例，胆固醇沉着病3例。H-EUS和CH-EUS诊断恶性GB壁增厚的总体灵敏度、特异性和准确性分别为83.3%和89.6%，65%和98%（p < 0.001），73.1%和94.4%（p < 0.001）。H-EUS的观察者间一致性为中等（kappa = 0.51），而CH-EUS的观察者间一致性为显著（kappa = 0.77）。结果表明，CH-EUS的不均匀强化模式是恶性胆囊壁增厚的强预测因子，CH-EUS有可能提高胆囊壁增厚的术前诊断准确性和鉴别诊断的一致性。
Differentiation of gallbladder (GB) carcinoma from benign GB wall thickening is challenging. The recent introduction of second-generation ultrasonic contrast agents has made contrast harmonic imaging with EUS possible. The aim of our study was to evaluate the utility of contrast-enhanced harmonic EUS (CH-EUS) for the differential diagnosis of GB wall thickening.Thirty-six consecutive patients with GB wall thickening imaged by CH-EUS and then underwent surgery were enrolled in this study. After the lesions were observed with conventional harmonic EUS (H-EUS), CH-EUS was performed with intravenous injection of 0.015 ml/kg of Sonazoid. Three reviewers with various levels of experience of EUS (Reviewer A: experienced endosonographer, B: EUS trainee, C: experienced gastroenterologist with expertise in transabdominal ultrasound but no EUS experience) were blinded to findings of recorded video of H-EUS and CH-EUS. The diagnostic accuracy of H-EUS and CH-EUS for malignant GB wall thickening was compared.Final diagnoses based on surgical histology were GB carcinoma in 16, cholecystitis in 11, adenomyomatosis in 6 and cholesterolosis in 3. Overall sensitivity, specificity and accuracy for diagnosing malignant GB wall thickening of H-EUS and CH-EUS were 83.3 versus 89.6, 65 versus 98 % (p < 0.001) and 73.1 versus 94.4 % (p < 0.001). The inter-observer agreement for H-EUS was moderate (kappa = 0.51), whereas that for CH-EUS was substantial (kappa = 0.77). The inhomogeneous enhanced pattern on CH-EUS was a strong predictive factor of malignant GB wall thickening.CH-EUS has the potential to improve the preoperative diagnostic accuracy and inter-observer agreement in the differential diagnosis of GB wall thickening.