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目的:探讨胃充盈双重超声造影(DCUS)定量参数术前无创预测胃癌淋巴结转移的价值。方法:回顾性收集2021年12月至2023年10月兰州大学第二医院119例经手术切除胃癌患者，依据病理结果分为伴淋巴结转移组(N1组，94例)和不伴淋巴结转移组(N0组，25例)。所有患者均于术前3 d内接受胃充盈DCUS检查。回顾两组病灶部位、超声T分期及分化程度，获取并分析始增时间(AT)、达峰时间(TTP)、基础强度(BI)、峰值强度(PI)及曲线上升支斜率(WIS)等超声造影定量参数，计算病灶增强强度ΔPI(ΔPI＝ PI–BI)和增强时间ΔTTP(ΔTTP＝ TTP–AT)。采用二元Logistic回归分析确定预测胃癌淋巴结转移独立危险因素并建立回归模型。采用Hosmer-Lemeshow拟合优度检验评价风险评估的一致性，Delong检验比较各预测模型的效能差异。结果:超声T分期和分化程度在N1组和N0组间差异有统计学意义(均 P<0.05)。超声造影定量参数PI、ΔPI和WIS在两组间差异有统计学意义(均 P<0.05)；而BI、AT、TTP、ΔTTP差异无统计学意义(均 P>0.05)。Logistic回归分析显示，超声T分期和WIS是胃癌伴发淋巴结转移的独立预测因子，构建的回归模型曲线下面积为0.905，预测淋巴结转移的准确性为93.3%，敏感性为95.7%，特异性为84.0%，优于单纯胃充盈DCUS定量参数构建的预测模型( P<0.05)。 结论:胃充盈DCUS定量参数可对术前判断胃癌淋巴结转移提供一定的依据，联合超声T分期可提高淋巴结转移的预测准确性。

Objective:To explore the feasibility of using quantitative parameters of double contrast-enhanced ultrasound (DCUS) to noninvasively predict lymphatic metastasis in gastric cancer before operation.Methods:From December 2021 to October 2023, 119 patients undergoing gastrectomy at the Second Hospital & Clinical Medical School, Lanzhou University, were enrolled retrospectively. Based on the pathological findings, they were divided into lymph node metastasis (N1, 94 cases) and non-lymph node metastasis (N0, 25 cases) groups. All patients underwent DCUS within 3 days before surgery. Previous to DCUS, lesions′ location and ultrasonic T-staging were recorded by conventional ultrasound. Quantitative parameters such as arrival time (AT), time to peak (TTP), baseline intensity (BI), peak intensity (PI) and wash-in slope (WIS) were obtained by the time-intensity curve (TIC) automatically, and then manually calculated enhanced intensity (ΔPI=PI–BI) and enhanced time (ΔTTP=TTP–AT). Binary Logistic regression analysis was used to screen independent risk factors for predicting lymph nodes metastasis in gastric cancer, and regression models were established.Results:Statistical tests revealed significant differences in ultrasonic T-staging ( P<0.001) and degree of differentiation ( P=0.015) between N1 and N0 group. Among DCUS quantitative parameters, statistical differences in PI, ΔPI and WIS were observed between the two groups (all P<0.05), while no significant differences were found in BI, AT, TTP and ΔTTP (all P>0.05). Logistic regression analysis showed that ultrasonic T-staging and WIS were independent risk factors for predicting lymphatic metastasis. The regression model built on the above two factors performed well in predicting lymph nodes metastasis, with an area under the curve of 0.905, accuracy of 93.3% (superior to the prediction model based on DCUS quantitative parameters alone, P<0.05), sensitivity of 95.7% and specificity of 84.0%. Conclusions:DCUS quantitative parameters may be helpful to evaluate lymphatic metastasis of gastric cancer prior to surgery, and the accuracy of prediction would be improved by combing with ultrasonic T-staging.