【摘要】 目的探讨超声造影到达时间成像(P-MFI)在肝移植后缺血性胆管炎诊断中的应用价值。方法收集38例临床确诊的缺血性胆管炎(ITBL)病例,60例肝移植术后正常病例,12例健康对照组,分别对各组病例进行肝脏的超声造影检查,并对图像进行后处理,得到P-MFI图像。观察比较各组到达时间图像特征,2名医师对超声造影动态图像及到达时间成像进行诊断信心评分。结果健康对照组图像与肝移植术后正常组特征:肝动脉首先显影为红色,胆管壁与门静脉管壁紧随其后:颜色多为黄绿色或绿色,最后是门静脉与大部分肝实质显影为深蓝或紫色,胆管壁显示清晰。缺血性胆管炎组特征:肝动脉首先显影为红色,门静脉壁随后显影,为黄色或绿色,胆管壁随后显影为绿色(4例),见零星点状绿色显示(6例),颜色显示为稀疏深蓝或紫色(14例),胆管壁无颜色填充(14例),大部分病例胆管壁显影较晚,充填不完整。门静脉及肝实质显影,多为蓝色或蓝紫色。对于ITBL组,两位医师对超声造影与P-MFI的诊断评分均具有统计学差异(0.000,0.000);对照组中两位医师对超声造影与P-MFI的诊断评分均无统计学差异(0.050,0.083)。诊断ITBL敏感性,特异度及准确性由68.4%、100%、89.1%提高至89.5%、100%、96.4%(医师1),由57.9%、94.4%、97.2%提高至89.5%、97.2%、94.5%(医师2)。两位评价者一致性较高(Kappa=0.811)。结论超声造影到达时间成像技术融合时间参数,更直观、清晰的显示组织、病变的血流灌注情况,大大丰富了超声造影的临床应用范围、超声造影必将在临床发挥更大的作用。更多还原

【Abstract】 Objective To evaluate the clinic value of parameter micro flow imaging (P-MFI) in diagnosing ischemic type biliary lesions(ITBL) after orthotopic liver transplantation. Methods 38 patients with ITBL and 60 recipients without any complications after orthotopic liver transplantation as well as 12 healthy volunteers underwent contrast-enhanced ultrasound(CEUS) focusing on bile duct wall(BDW) at the porta hepatics and adjacent liver parenchyma. The CEUS and P-MFI of BDW and liver parenchyma were evaluated by 2 sonologists for ITBL. Results The P-MFI of normal control group and liver transplant recipients without complications was similar with hepatic artery visualized in red first followed by BDW in yellow or green, and finally the liver parenchyma in blue or purple colors. In ITBL, the BDW was often visualized later than liver parenchyma as blue, purple or no color filling indicating lack of blood perfusion. The diagnostic confidence levels of P-MFI in ITBL were significantly higher than that of CEUS by both sonologists(0) with κ value of 0. 811. Conclusion The P-MFI offers higher confidence level than CEUS in diagnosing ITBL after liver transplant.更多还原