| Objective:To investigate the imaging features and clinical value of extrahepatic bile duct carcinoma with the real-time contrast-enhanced ultrasonography(CEUS) and contrast-enhanced MRI(CEMRI).Material and methods: 1 Clinical data: Fifty-six cases of extrahepatic bile duct cancer patients in our hospital were collected from January 2009 to December 2013,including 21 cases of male,35 cases of female;age 42~80 years, average 65 years old.All patients were underwent CEUS and CEMRI examination preoperatively and resected tissues were taken into pathological examination postoperatively. 2 Apparatus and method: Acuson Sequoia 512 color doppler ultrasonic diagnostic apparatus was used in these cases and the probe frequency was 1 ~ 4 MHz. All patients were applied to abrosia with 12 h before the examination.First,conventional ultrasonography was used for liver,bile,pancreas and spleen,specially for the morphology of liver,the dilatation of intrahepatic and extrahepatic bile duct,the size of gallbladder,the location,size and shape of the tumor,the lymph nodes surrounding the biliary and the retroperitoneal lymph nodes and then we determined the location and cause of obstruction of bile duct. If the lesion is smaller, or because of the interference by by the lower bowel chamber gas, drinking water, fat meal test can be further used. Additionally,we can selectively take local amplification to the superposition of two harmonic imaging on the basis of conventional ultrasonography.Six sulphur hexafluoride microbubbles was the contrast agent for CEUS And mechanical index of CEUS was 0.21.The location of the lesion was determined by conventional ultrasound, then the best position and the observation section was selected, and finally the harmonic contrast state was taken.we used Sono Vue(Bracco co.ltd).5 ml saline was taken into the bottle before using and then shaking to the suspension.A dose of 2.4 ml was taken into the antecubital vein by a way of bolus injection each time. GE Signa-HDx 3.0T scanner was using in these cases too. Water deprivation was taken in all patients before examination. Firstly axial, coronal and sagittal scanning was taken by T1W1, fat suppression T2W1 sequence conventionally, and the scanning scope was from the dome of the diaphragm to the pelvic cavity,then arterial phase scanning was taken after 20 s of the injection of contrast agent,portal venous phase scanning after 45 s and the delay period scanning after 3min,. The images were collected after the three times’ scanning. Analysis of images of CEUS and CEMRI: the lesion location and range, signal characteristics, invasions of ducts and vessels of hepatic portal area,lymph node metastasis of the liver and peritoneal were observed by 2 senior imaging doctors.And then we evaluated the echo of lesions and the level and form of CEUS and CEMRI.Result: 1 Ultrasound results: conventional ultrasonography showed low echo of 23 lesions(23/56), iso-echoic of 27 lesions(27/56) and high echo of 6 lesions(6/56) among the 56 cases of extrahepatic bile duct carcinoma.Color doppler ultrasonography showed visible internal blood flow signal in 17 lesions(17/56) and 39 lesions(39/56) without obvious blood flow signal. Images began enhancing after average 15.5±2.0s of injection of the contrast agent. Enhancement peaked at average 22.5±3.0s,and then contrast agent began fading down at average 55.5±9.0s and the echo of lesions was below the surrounding liver parenchyma.Among these cases,22 of the lesions(22/56) enhancement were earlier than liver parenchyma, and 34 lesions(34/56) enhancement were companied with it. CEUS of all lesions showed"entering and exiting quickly",and the echo of portal venous phase and delayed phase were weakened, but arterial enhanced in arterial phase. The echo of lesions was mostly enhanced highly(37/56,66.0%)in the arterial phase,but weakened mostly in portal venous phase(50/56,89.3%) and delayed phase(56/56,100%).When peaking, 34 lesions were enhanced inhomogeneously(34/56), while the other lesions(22/56) homogeneously.2 Results of MRI: T1W1 scanning of unenhanced MRI showed low signal of 50 lesions and equisignal of 6 lesions; T2W1 scanning displayed high signal of 48 lesions, equisignal of 6 lesions and low signal of 2 lesions. Results of CEMRI showed that lesions high enhancement in arterial phase(37/56, 66.0%), equal enhancement mainly in the portal phase(29/56,51.7%),high enhancement(17/56,30.3%) or equal enhancement(33/56,58.9%) mostly in delayed phase.When peaking, 39(39/56) lesions were enhanced inhomogeneously,but 17(17/56) were homogeneous among the 56 cases of extrahepatic bile duct carcinoma.Conclusions:Comparing CEUS with CEMRI and analyzing different performance in portal venous phase and delayed phase,CEUS could be a useful supplement for CEMRI,which provides important imaging evidence in the diagnosis of extrahepatic bile duct carcinoma for the patients who are clinically highly suspected extrahepatic bile duct carcinoma. |
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