Real-time Grey Scale Contrast-enhanced Ultrasonography In Diagnosis Of Gallbladder Cancer

ObjectiveTo explore the clinical value and charateristics of contrast-enhanced ultrasound(CEUS)in diagnosis of gallbladder carcinoma.Methods384patients with benign and malignant gallbladder disease were examined by CEUS.The characteristics of CEUS were analyzed and compared with pathologicalexamination.All the fundamental ultrasound examinations were performed by the Siemens SequoiaAcuson512or Philips iU22, which were matched with contrast pulse sequence (CPS）imaging technique. The frequency used in the mode of gray-scale US was1to4MHz,with2to5MHz in the modes of CEUS, respectively. Mechanical index(MI) was0.04to0.10. The contrast agent(UCA) was SonoVue (Bracco，Italy). Dissolve the SonoVuepower with5ml saline, then dump the solution and inject it to patient’s body quicklyby the needle which was set in cubital vein, and inject2.4ml saline to body. Theprocess of CEUS was divided into three phases, arterial phases (after injection to10s),portal phases (35sto120s), parenchymal paases (120s to360s).Results(1)The CEUS patterns of Gallbladder carcinomas showed quick and heterogeneoushyper-enhancement at the early arterial phases. The CEUS shape of the gallbladdercarcinomas were irregular. The wall of gallbladder was irregular thicken andinterrupted by the mass. The basement of lesions were wide and connected with thegallbladder wall. Almost all the gallbladder carcinomas showed washout from hyper-enhancement to hypo-enhancement quickly after contrast agent administration.The CEUS patterns of Gallbladder benign uplift venereal change lesions showedquick and homogeneous hyper-enhancement at the early arterial phases. The CEUSappearances of Gallbladder benign uplift venereal change lesions were regular. Thewall of gallbladder was succession,without intermittent phenomenon. The basementof lesions were narrow or no basal department. Almost the Gallbladder benign upliftvenereal change lesions showed washout from hyper-enhancement tohypo-enhancement slowly after contrast agent administration. The biliary mudwithout enhanced.(2) It was significant different between benign and malignant gallbladder diseases ofCEUS characteristics (P<0.05).(3)Compared with pathological examination, the sensitivity, specificity and accuracyof CEUS in gallbladder carcinomas diagnosis was96.6%(28/29),99.4%(353/355),99.2%（381/384）respectively.Conclusions(1).Through the CEUS of gallbladder benign and malignant lesions after signsobserved analysis,CUES can effectively improve the gallbladder of ultrasonicdiagosis and differential diagnosis,for the correct diagnosis and early gallbladderguide treatment formulation to provide important clinical value.(2).The CEUS Can real-time dynamic display of the gallbladder internalmicrovascular perfusion process.(3).The CEUS can determine how extensive the gallbladder and the relationship withthe surrounding tissue,for gallbladder surgery with the scope provide good guidanceand curative effect evaluation.(4).The CEUS can clear diagnosis of viscous bile mud, inflammatory exudate and bigstones under the cover of small tumors.(5).But the CEUS on part of benign and malignant lesions because of its blood flowand other overlapping filling way,the differential diagnosis is still difficult.