探讨双重对比超声造影（D-CEUS）在壶腹周围病变检出中的应用价值。

回顾性分析2006年7月至2012年12月在中山大学附属第三医院均接受D-CEUS和增强MRI检查的43例壶腹周围病变患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男29例，女14例；平均年龄（56±2）岁。43例患者中共有45个病灶，其中30个为恶性病灶，包括十二指肠乳头癌13个，胆总管下端癌7个，胰腺钩突癌6个，壶腹癌4个；15个为良性病灶，均为胆总管下端结石。所有病灶均经手术病理活组织检查或胆道镜直视证实。对比D-CEUS与增强MRI对壶腹周围病变的检出率，以及对壶腹周围恶性病变与周围组织关系的显示率。两组率的比较采用χ²检验。

两种检查方法均能较清晰显示壶腹周围病变。D-CEUS对壶腹周围病变的检出率为98%（44/45），增强MRI为96%（43/45），差异无统计学意义（χ²=0.345，P>0.05）。D-CEUS对壶腹周围恶性病变与周围组织关系显示清的病灶占77%（23/30），显示欠清的病灶占20%（6/30），显示不清的病灶占3%（1/30）；增强MRI相应为86%（26/30）、7%（2/30）、7%（2/30），差异无统计学意义（χ²=2.517，P>0.05）。

D-CEUS对壶腹周围病变有较高的检出率，其检出能力与增强MRI相近，可作为增强MRI的重要补充甚至替代方法。

To explore the value of double contrast enhanced ultrasound (D-CEUS) in detection of periampullary lesions.

Clinical data of 43 patients with periampullary lesions who received examinations of D-CEUS and contrast-enhanced magnetic resonance imaging (MRI) both in the Third Affiliated Hospital of Sun Yat-sen University from July 2006 to December 2012 were analyzed retrospectively. The informed consents of all patients were obstained and the ethical committee approval was received. There were 29 males and 14 females with a mean age of (56±2) years old. There were totally 45 lesions in 43 patients, including 30 malignant lesions (13 duodenal papillary carcinomas, 7 distal common bile duct carcinomas, 6 pancreatic uncinate process carcinomas, 4 ampullary carcinomas) and 15 benign lesions which all were distal common bile duct stones. All the lesions were confirmed by surgical pathological biopsy or choledochoscope. The detection rates of periampullary lesions and the display rates of relation between periampullary malignant lesions and surrounding tissues by D-CEUS and contrast-enhanced MRI were compared. The rates of 2 groups were compared by Chi-square test.

Periampullary lesions could be displayed clearly both by 2 examination methods. The detection rate of periampullary lesions was 98% (44/45) by D-CEUS and was 96% (43/45) by contrast-enhanced MRI, where no significant difference was observed (χ²=0.345, P>0.05). For the display of relation between periampullary malignant lesions and surrounding tissues, 77% (23/30) was well-defined, 20% (6/30) was poorly-defined, and 3% (1/30) was ill-defined by D-CEUS, while it was 86% (26/30), 7% (2/30), 7% (2/30) by contrast-enhanced MRI accordingly, where no significant difference was observed (χ²=2.517, P>0.05).

D-CEUS has a high detection rate of periampullary lesions. Its detection ability is similar to contrast-enhanced MRI, and it can be an important supplement to, even a replacement for contrast-enhanced MRI.