超声内镜检查术与注射用六氟化硫微泡造影增强超声内镜检查术对上消化道黏膜下肿瘤的诊断价值

Diagnostic value of endoscopic ultrasonography and contrast-enhanced endoscopic ultrasonography with sulfur hexafluoride microbubbles for injection in upper submucosal tumors

摘要:

目的 探讨超声内镜检查术（EUS）与注射用六氟化硫微泡造影增强超声内镜检查术（CE-EUS）对上消化道黏膜下肿瘤（SMT）的诊断价值。方法 选择2021年1月－2023年8月该院收治的上消化道SMT患者82例，所有患者均接受EUS和以六氟化硫微泡为造影剂的CE-EUS，分析EUS和以六氟化硫微泡为造影剂的CE-EUS下的上消化道良性SMT和胃肠道间质瘤（GIST）的图像特征。以手术病理结果为金标准，比较EUS、以六氟化硫微泡为造影剂的CE-EUS单独检查，以及两者联合检查，在上消化道良性SMT和GIST鉴别诊断中的应用价值。结果 82例上消化道SMT经影像学检查和手术结果证实，肿瘤位于食管上段、食管中段、食管下段、贲门、胃底、胃体、胃窦和十二指肠球部的占比分别为7.32%、10.98%、10.98%、4.88%、29.27%、26.83%、6.10%和3.66%。病理检查结果显示，良性SMT 51例，占比62.20%；GIST 31例，占比37.80%。其中，良性SMT主要位于食管和胃部，并以平滑肌瘤最为多见；GIST主要位于胃部，并以胃底和胃体多见。良性SMT组回声均匀、表面黏膜光滑和边缘规则占比明显高于GIST组，差异均有统计学意义（P < 0.05）。GIST组多普勒丰富血流信号和起源于固有肌层占比明显高于良性SMT组，差异均有统计学意义（P < 0.05）。两组患者回声性质占比比较，差异无统计学意义（P > 0.05）。良性SMT组同质性强化占比明显高于GIST组，差异有统计学意义（P < 0.05）。GIST组动脉期高增强、静脉期弥漫性增强和不规则血管占比明显高于良性SMT组，差异均有统计学意义（P < 0.05）。EUS鉴别诊断GIST和良性SMT的敏感度、特异度和准确性分别为64.52%、74.51%和70.73%，以六氟化硫微泡为造影剂的CE-EUS分别为90.32%、88.24%和89.02%，两者联合检查分别为100.00%、90.20%和93.90%。结论 EUS与以六氟化硫微泡为造影剂的CE-EUS，对上消化道良性SMT和GIST具有较好的鉴别诊断价值。

Abstract:

Objective To investigate the diagnostic value of endoscopic ultrasonography (EUS) and contrast-enhanced endoscopic ultrasonography (CE-EUS) with sulfur hexafluoride microbubbles for injection in upper gastrointestinal submucosal tumors (SMT).Methods The subjects of this study were 82 upper gastrointestinal SMT patients from January 2021 to August 2023. All of them underwent EUS and CE-EUS using sulfur hexafluoride microbubbles as contrast agents. Features of EUS images of upper gastrointestinal benign SMT and gastrointestinal stromal tumor (GIST), and CE-EUS images using sulfur hexafluoride microbubbles as contrast agents were analyzed. EUS, CE-EUS using sulfur hexafluoride microbubbles as contrast agents, and combination of the two were compared in upper gastrointestinal benign SMT and GIST diagnosis based on surgical pathological findings as the golden standard.Results 82 cases of upper gastrointestinal SMT were confirmed by imaging examination and surgical results to have tumors located in the upper, middle, lower segments esophagus, cardia, fundus, body, antrum of stomach, and duodenal bulb, accounting for 7.32%, 10.98%, 10.98%, 4.88%, 29.27%, 26.83%, 6.10%, and 3.66% respectively. According to pathological results, there were 51 cases of upper gastrointestinal benign SMT, accounting for 62.20% and 31 cases of GIST, accounting for 37.80%. Among them, SMT in the upper gastrointestinal tract was mainly located in the esophagus and stomach, with leiomyoma being the most common. GIST was mainly located in the stomach and was more common in the fundus and body of the stomach. The proportion of benign SMT group with uniform echo, smooth surface mucosa, and regular edges was significantly higher than that of GIST group (P < 0.05). GIST group had much higher proportion in doppler rich blood flow signals and origination from the muscularis propria than benign SMT group did (P < 0.05). There was no difference between the two groups in terms of proportion of echo properties (P > 0.05). The proportion of homogeneous enhancement in the benign SMT group was significantly higher than that in the GIST group (P < 0.05). The proportion of arterial phase hyperenhancement, venous phase diffuse enhancement, and irregular blood vessels in the GIST group was significantly higher than that in the benign SMT group (P < 0.05). The sensitivity, specificity, and accuracy of EUS in distinguishing GIST and benign SMT were 64.52%, 74.51%, and 70.73% respectively, those of the CE-EUS using sulfur hexafluoride microbubbles as contrast agent were 90.32%, 88.24%, and 89.02% respectively, and those of EUS + CE-EUS using sulfur hexafluoride microbubbles as contrast agent were 100.00%, 90.20%, and 93.90% respectively.Conclusion EUS and CE-EUS with sulfur hexafluoride microbubbles as contrast agents has high diagnostic value for upper gastrointestinal benign SMT and GIST.