| Objective:To study high-frame-rate contrast-enhanced ultrasound(H-CEUS)combined with gallbladder reporting and data system(GB-RADS)and micro flow imaging(MFI)in the diagnosis and differential diagnosis of polypoid lesion of gallbladder(PLG).The diagnostic efficacy of the above three diagnostic methods and their combination in the differential diagnosis of non-malignant and malignant PLG was discussed.Methods:Patients with polypoid lesions of the gallbladder who were treated in Hebei General Hospital from December 2021 to October 2022were selected.Among them,67 patients underwent surgical treatment and obtained pathological results,including 34 males and 33 females,aged22～74(51.1±12.9)years old.According to the postoperative pathological results as the gold standard,54 cases were divided into non-malignant group,the maximum size of lesions was 10.4～21.3(14.9±2.6)mm,including 27 cases of cholesterol polyps,15 cases of adenoma and 12 cases of adenomyosis of gallbladder.The malignant group included 13 cases of gallbladder carcinoma,and the maximum size of the lesion was 15.1～39.8(22.9±6.6)mm.First,all patients underwent conventional ultrasound examination and color doppler flow imaging(CDFI)to measure the size of the lesion,observed the number of lesions,echo,thickening of the gallbladder wall and whether there was blood flow signal.Then the best scanning section of the lesion was selected,and MFI examination was performed to observe the blood flow display inside the lesion.The diagnostic criteria referred to Alder semi-quantitative method.The contrast agent was injected with sulfur hexafluoride microbubbles(Sono Vue).The real-time observation time was not less than 3 minutes after injection of contrast agent,and the dynamic contrast process was saved.The internal vascular architecture of polypoid lesions,the way of blood flow in and out,the degree of enhancement,the condition of the attached gallbladder wall and the integrity of the gallbladder wall were observed and compared with the final pathological results.The maximum diameter of polyps conformed to the normal distribution and was expressed as(x~—±s).The t test was used to compare the difference between the non-malignant group and the malignant group.The count data were expressed as the number of cases,and the differences between the non-malignant group and the malignant group were analyzed by chi-square test,Pearson chi-square or Fisher’s exact test.The sensitivity,specificity and accuracy of H-CEUS,MFI,GB-RADS classification and the combination of the three were calculated,and the receiver operating characteristic curve(ROC)was constructed.The area under curve(AUC)was calculated.P<0.05 was considered statistically significant.Results:1.Comparison of conventional ultrasound,GB-RADS classification and CDFI characteristics between the two groups of PLG patients,conventional ultrasound showed that the maximum size of the lesion was malignant group>non-malignant group(22.9±6.6mm vs 14.9±2.6mm),the difference was statistically significant(P=0.001).There were 54 cases in the non-malignant group.GB-RADS grade 0～2 accounted for 64.8%(35/54),and 66.7%(36/54)of CDFI showed no blood flow signal.There were 13 cases in the malignant group.GB-RADS grade 3～5 accounted for69.2%(9/13),CDFI showed blood flow signals accounted for 76.9%(10/13),the differences were statistically significant(P<0.05).2.Comparison of blood flow grading between the two groups of lesions by MFI examination,83.3%(45/54)of the non-malignant group were grade 1～2,and 16.7%(9/54)were grade 3～4;in malignant group,grade 1～2 accounted for 30.8%(4/13),grade 3～4 accounted for 69.2%(9/13),the difference was statistically significant(P<0.05).3.H-CEUS feature analysis:The contrast enhancement features of the non-malignant group and the malignant group were compared and analyzed.There were statistically significant differences between the two groups in terms of access methods,vascular architecture morphology,enhancement level,gallbladder wall thickening and enhancement at the attachment,and integrity of the gallbladder wall(P<0.05).In the non-malignant group,PLG showed non-hyperenhancement in the arterial phase(53.7%,29/54),and the entry and washout modes were mostly’synchronous entry’(55.6%,30/54)and’synchronous washout’(55.6%,30/54).The vascular morphology was mostly spotted(38.9%,21/54)and single-branched vessels(42.6%,23/54).After angiography,most of the gallbladder walls attached to the lesions showed no obvious thickening and hyper-enhancement(72.2%,39/54),and the gallbladder walls were intact(98.1%,53/54).In the malignant group,the arterial phase of PLG was mainly characterized by hyper-enhancement(92.3%,12/13),and the entry and washout modes were mostly’fast entry’(84.6%,11/13)and’fast washout’(84.6%,11/13).The vascular morphology was mostly multi-branched vessels(76.9%,10/13).After angiography,the gallbladder wall at the lesion attachment was thickened and hyper-enhanced(92.3%,12/13),of which 72.9%(10/13)had gallbladder wall integrity damage.4.Postoperative pathology was used as the gold standard,the ROC curves of GB-RADS grading,MFI,H-CEUS and their combination in the diagnosis of PLG in the two groups were drawn.The results showed that the AUC and 95%CI were 0.707(0.546～0.869,P=0.021),0.763(0.604～0.922,P=0.003),0.811(0.666～0.955,P=0.001),0.886(0.764～1.000,P<0.001).The diagnostic accuracy of GB-RADS classification,MFI,H-CEUS and their combined diagnosis for PLG in the two groups was 71.6%,80.6%,83.6%and 91.0%,respectively.The accuracy of the above four diagnostic methods was compared between groups,and the difference was statistically significant(χ2=8.666,P=0.034).The combined application of the three diagnostic methods is superior to the single diagnostic method in the diagnosis of PLG.Conclusion:The three diagnostic methods of GB-RADS classification,MFI and H-CEUS reflect the characteristics of different aspects of the lesion from different angles,and each has its own advantages.The combined diagnostic accuracy of the three is the highest,which is more helpful to determine whether there is cancer.Early diagnosis of malignant lesions is helpful for clinicians to choose appropriate treatment methods,improve the survival rate of patients and improve the quality of life after surgery. |
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