The Diagnostic Value Of Contrast-enhanced Ultrasound In Diagnosing Polypoid Lesions Of Gallbladder

Objectives To investigate the value of contrast-enhanced ultrasound(CEUS)in diagnosing polypoid lesions of gallbladder(PLG)by comparing and analyzing the different diagnostic indexes of CEUS and conventional ultrasound according to the pathological results.Methods There were 190 in 205 patients diagnosed PLG by conventional ultrasound as object of study according to the selected standard and the excluded standard from January 2015 to September 2017 in Tangshan People Hospital.The ultrasonic instrument was LOGIQ E9 with convex array probe.Many kinds of scanning technique like sidewards scan were used in conventional ultrasound examination.Diagnostic indexes of conventional ultrasound had size,shape,internal echo and internal blood flow.Ultrasound contrast agent(SonoVue)was administered as a bolus through the antecubital vein at a dose of 1.5ml,followed by a flush of 5ml normal saline.The timer should be activated at the beginning of contrast agent administration and the lesion was observed intermittently for at least 5 min.All data of CEUS was stored and analyzed after the examination.Diagnostic indexes of CEUS had initial enhancement time,time to hypo-enhancement,distribution characteristic of contrast agent,integrity of the gallbladder wall,enhancement of venous phase and enhancement of arterial phase.All the diagnostic indexes were compared according to the pathological results.The indexes with significant difference were analyzed by consistency test or two classification nonlinear logistic regression analyses.The diagnostic test and joint test were used to analyze the meaningful diagnostic indexes and evaluate the value of CEUS in the diagnosis of PLG.Results 1 There was statistically significant difference in size and shape(P<0.05)between benign and malignant lesions,but there was no statistically significant difference in internal echo and internal blood flow(P>0.05).There was statistically significant difference in time to hypo-enhancement,distribution characteristic of contrast agent,integrity of the gallbladder wall and enhancement of venous phase(P<0.05)between benign lesions and malignant lesions,but there was no statistically significant difference in initial enhancement time and enhancement of arterial phase(P>0.05).2 The valuable diagnostic indexes were shape,time to hypo-enhancement,distribution characteristic of contrast agent and integrity of the gallbladder wall.3 The sensitivity,specificity,Youden's index and the area under the ROC curve were 72.7%,82.4%,0.551 and 0.775 when using irregular shape as a diagnostic criterion.The sensitivity,specificity,Youden's index and the area under the ROC curve were 84.1%,67.6%,0.517 and 0.759 when using time to hypo-enhancement<35s as a diagnostic criterion.The sensitivity,specificity,Youden's index and the area under the ROC curve were 73.9%,100%,0.739 and 0.869 when using disruption of the gallbladder wall integrity as a diagnostic criterion.The sensitivity,specificity,Youden's index and the area under the ROC curve were 75.0%,63.7%,0.387 and 0.694 when using distribution of contrast agent heterogeneous as a diagnostic criterion.4 The best joint test of CEUS in diagnosing malignant lesions: disruption of the gallbladder wall integrity was parallelled after time to hypo-enhancement<35s and distribution of contrast agent heterogeneous in series.The sensitivity,specificity,Youden's index and the area under the ROC curve were 89.8%,73.5%,0.633 and 0.837.The best joint test of joint examination in diagnosing malignant lesions: they were in series after time to hypoenhancement<35s parallel distribution of contrast agent heterogeneous and shape parallel disruption of the gallbladder wall integrity.The sensitivity,specificity,Youden's index and the area under the ROC curve were 88.6%,94.1%,0.827 and 0.913.Conclusions 1 The diagnostic indexes of CEUS which had high value included time to hypo-enhancement,distribution characteristic of contrast agent and integrity of the gallbladder wall in diagnosing PLG.2 The best diagnostic criterion of CEUS in diagnosing malignant PLG: time to hypo-enhancement < 35 s and distribution of contrast agent heterogeneous were concurrent,with or without disruption of the gallbladder wall integrity.3 The combination of CEUS and conventional ultrasound was better than using CEUS alone in diagnosing PLG.