Comparison Study Of Contrast-enhanced Ultrasound And Contrast-enhanced CT In Benign And Malignant Lesions Of The Gallbladder

Objective:By using contrast-enhanced ultrasound(CEUS)and enhanced CT(CECT)technology,to observe and analyze the enhancement level and enhanced morphology,enhancement pattern and substrate,the gallbladder wall integrity and gallbladder carcinoma TNM staging diagnosis of benign and malignant lesions of the gallbladder,performance comparison of CEUS and CECT technology in the differential diagnosis of benign and malignant lesions of the gallbladder.Methods:To our hospital for routine ultrasound and CT scan after the examination,suspected of gallbladder occupying lesions of patients,contrast enhanced ultrasound and contrast-enhanced CT were performed,comparative study of image features of benign and malignant gallbladder lesions,the results were compared with the pathological results.Results:48 cases were confirmed by pathology,including gallbladder carcinoma in 19 cases,gallbladder benign lesions in 29 cases(gallbladder polyps in 10 cases,gallbladder adenoma in 3 cases,gallbladder adenomyomatosis in 8 cases,biliary sludge or calculus in 8 cases).Two-dimensional contrast-enhanced ultrasonography: gallbladder lesions in 8 cases of conventional ultrasound to qualitative(biliary sludge and / or calculi)are always no enhancement(diagnosis rate is 100%).40 cases of cystic lesions of malignant group(19cases)and control group(21 cases): the lesions of gallbladder diameter(3.80 + 1.66 cm,1.75 + 0.73 cm,P < 0.05),late arterial enhancement degree(15/19vs2/21,78.95%vs9.53%,P < 0.05),cystic wall continuity(14/19vs21/21,73.68%vs100%,P <0.05),the lesions of basal(18/19vs6/21,94.74%vs28.57%,P < 0.05)were statistically significant.The other two groups with high levels of early arterial enhancement enhancement(17/19vs16/21,89.47%vs76.19%,P=0.493),(11/19vs8/21,57.89%vs38.09%,P=0.351),the time intensity curve area for 1 minutes under the curve(864.13 + 215.25885.75 + 208.77,P=0.749)had no significant difference.The two-dimensional contrast-enhanced ultrasonography in differential diagnosis of benign and malignant gallbladder lesions the sensitivity,specificity and accuracy were 94.71%,90.48%,92.50%,the positive predictive value was 90%,the negative predictive value was 95%,indicating Kappa is 0.849,contrast-enhanced ultrasound and postoperative pathological diagnosis results have good consistency,diagnostic ultrasound angiography results were close to or reach after the results of pathological diagnosis.Three-dimensional contrast-enhanced ultrasonography: gallbladder lesions in 8 cases of conventional ultrasound to qualitative(biliary sludge and / or calculi)are always no contrast agent into the(detection rate 100%).40 cases of malignant gallbladder lesions compared with benign lesion group: there were significant differences in the boundary between the internal enhancement,the lesions,and in the basement the cyst wall(P <0.05),the diagnostic sensitivity,specificity and accuracy were 94.74%,95.25%,95%,the positive predictive value was 94.74%,the negative predictive value was 94.74%.Enhanced CT:8 cases routine ultrasonic qualitative(biliary sludge / or calculi)showed no enhancement(100%).40 cases of malignant gallbladder lesions compared with benign lesion group: Internal Enhancement boundary between the lesion,morphology,and basal width and wall were statistically significant(P < 0.05),sensitivity,specificity and accuracy were 92.31%,94.87% and 94.23%,positive and negative predictive value were 94.44%,90.91%.Compared with postoperative pathological diagnosis results,Kappa value of =0.849,enhanced CT and postoperative pathological diagnosis results are in good agreement,indicating that the results of enhanced CT close to the results of postoperative pathological diagnosis. Contrast enhanced ultrasound and contrast enhanced CT: a comparative analysis of the sonographic features of malignant group,the enhancement level(early high enhancement,advanced low enhancement)and enhance the morphology,basal,gallbladder wall integrity,combined with common bile stones,mud / combined with local infiltration and metastasis were not statistically significant(P > 0.05).There was no significant difference between the two groups with respect to the characteristics of the benign group,the level of enhancement(early high enhancement,late low enhancement),enhancement of morphology,basement,and the integrity of the bile duct wall(P >0.05).According to the results of CEUS and CECT diagnosis and pathological results,the diagnostic rate of the two imaging methods(37/40,92.50%,37/40,92.50%,P=1.000)was not statistically significant.There was no significant difference between CEUS and enhanced CT in postoperative pathological diagnosis(chi square 2=0.000,P > 0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 94.74%,90.48%,92.50%,95%,Kappa value is0.850.The sensitivity,specificity and accuracy of CT in the diagnosis of gallbladder lesions were 89.47%,95.24%,92.50%,94.44% and 90.91%,respectively,and the Kappa value was=0.849.There was no significant difference between the results of contrast-enhanced ultrasound,contrast-enhanced CT and postoperative pathological diagnosis.Conclusion:(1)contrast-enhanced ultrasound and enhanced CT in the diagnosis of benign and malignant lesions of gallbladder were good consistency of contrast analysis.(2)Contrast enhanced ultrasound and enhanced CT in the diagnosis of gallbladder lesions have a high diagnostic efficacy,the combination of the two provide comprehensive imaging information to clinical treatment and TNM staging of gallbladder cancer.