探讨超声参数－造影剂到达时间成像(P-MFI)技术在肝移植术后缺血性胆管炎(ITBL)中的诊断价值。

回顾性分析2015年1月1日至2017年12月31日随访期间在中山大学附属第三医院确诊ITBL的25例肝移植受者(ITBL组)临床资料，选取同期肝移植术后随访中移植肝功能正常受者作为对照组(33例)。由2名分别具有8、2年腹部超声诊断经验的医师(医师1和医师2)采用双盲法，分别对所有病例进行超声造影及P-MFI诊断信心评分。采用成组t检验比较ITBL组与对照组年龄以及医师1和医师2对两组受者超声造影和P-MFI诊断信心评分。采用卡方检验或Fisher确切概率法比较两组受者性别、胆管吻合方式、原发病以及医师1和医师2对两组受者P-MFI诊断信心评分差异。采用Kappa检验评价医师1和医师2的诊断一致性。P<0.05为差异有统计学意义。

两组受者年龄、性别、胆管吻合方式和原发病等一般资料差异均无统计学差异(P均>0.05)。ITBL组和对照组受者平均P-MFI编辑时间分别为(8.2±1.8)s和(6.8±1.9)s，差异具有统计学意义(t＝－2.516，P<0.05)。对照组动脉首先显影，为红色；随后胆管壁与门静脉管壁显影(几乎为同一时段)，胆管壁显影清晰，20例为黄绿色或绿色，9例为绿色和蓝色混合，4例为蓝色与紫色相间；最后为门静脉与肝实质显影，颜色多为蓝色和紫色。ITBL组动脉首先显影，为红色；随后门静脉和肝实质显影，门静脉壁为黄色或绿色，门静脉及肝实质为蓝色或蓝色与紫色相间；最后胆管壁显影，胆管壁显影较晚且不清晰，其中8例颜色充填较好，为绿色，4例为零星点状绿色，10例为稀疏深蓝或紫色，3例无颜色填充。医师1超声造影和P-MFI平均诊断信心评分分别为(4.4±0.5)分和(4.8±0.3)分，差异有统计学意义(t＝25.35，P<0.05)。ITBL组和对照组分别有22、5例P-MFI诊断信心评分高于超声造影，两组差异有统计学意义(χ²＝50.088，P<0.05)。医师2超声造影和P-MFI平均诊断信心评分分别为(4.2±0.6)分和(4.7±0.5)分，差异有统计学意义(t＝22.52，P<0.05)；ITBL组和对照组分别有20、6例P-MFI诊断信心评分高于超声造影，两组差异有统计学意义(χ²＝40.798，P<0.05)。两位阅片者对于ITBL组和对照组受者评判一致性分别为较好和一般(Kappa值＝0.706和0.455)。

P-MFI技术可更直观、清晰显示胆管壁、肝脏血管及肝实质血流灌注情况，能为肝移植术后并发ITBL的诊断提供更丰富的信息，增强检查者的诊断信心。

To evaluate the diagnostic value of parameter micro flow imaging (P-MFI) in diagnosing ischemic-type biliary lesion (ITBL) after liver transplantation.

The clinical data of 25 liver transplantation recipients who were diagnosed with ITBL (ITBL group) during January 2015 and December 2017 in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed, and 33 recipients without any complications during the same follow-up period were seclected as control group. Two doctors (doctor 1 and doctor 2) with 8 or 2 years of experience in abdominal ultrasound diagnosis were selected to perform contrast-enhanced ultrasonography and P-MFI diagnostic confidence scores in all cases by double-blind method. Group t-test was used to compare the age of the 2 groups, and the confidence scores of contrast-enhanced ultrasonography and P-MFI between doctor 1 and doctor 2. Chi-square test or Fisher′s exact probability method was used to compare the gender, method of biliary anastomosis cholangiostomy, primary disease, and the difference of P-MFI diagnostic confidence scores of doctor 1 and 2 between the 2 groups. Kappa test was used to evaluate the diagnostic consistency between doctor 1 and doctor 2. P<0.05 was considered statistically significant.

There was no significant difference in general data (age, sex, bile duct anastomosis and primary diseases) between the 2 groups (P all>0.05). The average editing time of P-MFI in ITBL and control group was (8.2±1.8) s and (6.8±1.9) s, which with statistical significance (t=-2.516, P<0.05). In the control group, the arteries were first showed in red; then the wall of bile duct and portal vein were clearly visualized, and the color of bile duct wall was mostly yellow-green or green (20 cases), partly mixed with green and blue (9 cases) or blue-purple (4 cases); finally, the wall of portal vein and hepatic parenchyma was visualized in blue and purple. In the ITBL group, arteries were first showed in red, portal vein wall was yellow or green; then the portal vein wall was visualized in yellow and green, the portal vein and hepatic parenchyma were visualized in blue or blue-purple; finally, the wall of bile duct was visualized which was unclear, with better color filling in green (8 cases), sporadic dotted green (4 cases), sparse dark blue or purple (10 cases), no color filling (3 cases). The average diagnostic confidence scores of contrast-enhanced ultrasonography and P-MFI of doctor 1 were(4.4±0.5)mark and (4.8±0.3) mark respectively, which with statistical significance (t=25.35, P<0.05). In the ITBL group, 22 cases (22/25) had higher P-MFI diagnostic confidence score than contrast-enhanced ultrasonography, while in the control group, 5 cases (5/33) had higher P-MFI diagnostic confidence score (χ²=50.088, P<0.05). The average diagnostic confidence scores of contrast-enhanced ultrasonography and P-MFI of doctor 2 were (4.2±0.6) mark and (4.7±0.5) mark respectively, which with statistical significance (t=22.52, P<0.05). In the ITBL group, 20 cases (20/25) had higher P-MFI diagnostic confidence score than contrast-enhanced ultrasonography, while in the control group, 6 cases (6/33) had higher P-MFI diagnostic confidence score (χ²=40.798, P<0.05). The two reviewers had good and general consistency in judging the ITBL group and the control group respectively (Kappa=0.706 and 0.455).

The P-MFI can visualized the blood perfusion of wall bile duct, hepatic vascular and liver parenchyma more intuitive and clearer, which can provide more information for the diagnosis of ITBL and enhance the diagnostic confidence.