超声造影灌注时相分析在肝硬化背景下对肝脏增生结节的诊断价值

doi:10.3969/j.issn.1672-5069.2022.02.029

摘要/Abstract

摘要： 目的探讨超声造影(CEUS)灌注时相分析在肝硬化背景下对肝脏增生结节的诊断价值。方法 2017年6月～2020年6月我院诊治的肝硬化患者100例,均接受CEUS检查,获得超声造影定量参数,包括造影峰值强度(Peak)、达峰时间(TTP)和平均度越时间(MTT),记录两组局部血容量(RBV)和局部血流量(RBF)水平。结果经组织病理学检查,诊断增生结节(DN)54例和小肝细胞癌(sHCC)46例;在肝硬化背景下,DN组病灶无明显血流信号占53.9%,48.5%sHCC组病灶主要为低血流信号,两组均以低回声为主(79.6%对74.2%),边界清晰(91.1%对77.3%),形态规则(65.4%对74.2%,P>0.05);在动脉期、门脉期和延迟期,DN组分别以低(52.3%)、等(85.9%)和等增强(91.0%)为主,而sHCC组分别以高(86.4%)、等(63.6%)和低增强(60.6%)为主(P<0.05);DN组Peak、TTP和MTT分别为(46.4±13.5)%、(26.8±3.5)s和(53.3±7.8)s,与sHCC组【分别为(58.8±11.3%)、(24.2±4.3)s和(42.5±9.7)s】比,差异显著(P＜0.05);DN组动脉期RBV和RBF水平分别为(1562.8±618.3)mL和(1562.8±618.3)mL/s,延迟期分别为(612.3±95.3)mL和(25.7±6.9)mL/s,与sHCC组【分别为(3428.6±562.8)mL和(62.5±13.5)mL/s及(385.5±89.6)mL和(18.3±4.7)mL/s】比,差异显著(P＜0.05);CEUS诊断DN的准确率为87.0%,灵敏度为87.0%,特异度为87.0%,阳性预测值为88.7%,阴性预测值为85.1%(Kappa值=0.739)。结论 CEUS灌注时相分析可为在肝硬化背景下帮助鉴别诊断DN与sHCC,具有较高的临床应用价值。

关键词: 小肝细胞癌, 增生结节, 肝硬化, 超声造影, 定量分析

Abstract: Objective The aim of this study was to explore the clinical value of perfusion phase analysis of contrast-enhanced ultrasound (CEUS) in the diagnosis of patients with hyperplastic nodules with underlying liver cirrhosis. Methods 100 patients with cirrhosis were encountered in our hospital between June 2017 and June 2020, and all underwent CEUS check-up. The region of interest was drawn, and the peak, time to peak (TTP) and mean transit time (MTT) as well as the regional blood volume (RBV) and the regional blood flow (RBF) were recorded. Results Out of our 100 cirrhotics, the dysplastic nodule (DN) in liver was proven in 54 cases, and small hepatocellular carcinoma (sHCC) was confirmed in 46 cases by histopathological examination; no significant blood flow signals of lesions in DN was 53.9%, while the lesions of sHCC were mainly with low blood flow signals in 48.5%; the lesions in both groups were mainly with low echoes (79.6% vs. 74.2%), with clear boundaries (91.1% vs. 77.3%) and regular morphology (65.4% vs.74.2%); the enhancement features on CEUS images in DN were mainly on low (52.3%), equal (85.9%) and equal enhancement echoes (91.0%) in arterial phase, portal phase and delayed phase, while those in sHCC were mainly with high (86.4%), equal (63.6%) and low enhancement echoes (60.6%), respectively; the peak, TTP and MTT in DN were (46.4±13.5) %, (26.8±3.5) s and (53.3±7.8) s, all significantly different compared with those in sHCC [(58.8±11.3) %, (24.2±4.3) s and (42.5±9.7) s, respectively, P<0.05]; the RBV and RBF in DN in arterial phase were (1562.8±618.3) mL and (1562.8±618.3) mL/s, while in delayed phase were (612.3±95.3) mL and (25.7±6.9) mL/s, significantly different compared with [(3428.6±562.8) mL, (62.5±13.5) mL/s and (385.5±89.6) mL, (18.3±4.7) mL/s, P<0.05] in sHCC; the accuracy, sensitivity, specificity, positive predictive value and negative predictive value by CEUS in diagnosis of DN under cirrhosis background were 87.0%, 87.0%, 87.0%, 88.7% and 85.1%, respectively (Kappa value=0.739). Conclusion The perfusion phase analysis of CEUS could provide objective basis for the diagnosis of DN in patients with underlying liver cirrhosis, which might be of high clinical applicatione.

Key words: Small hepatocellular carcinoma, Dysplastic nodule, Cirrhosis, Contrast-enhanced ultrasound, Quantitative analysis

余涛, 付路路, 陈方, 田园. 超声造影灌注时相分析在肝硬化背景下对肝脏增生结节的诊断价值[J]. 实用肝脏病杂志, 2022, 25(2): 267-270.

Yu Tao, Fu Lulu, Chen Fang, et al. Clinical value of perfusion phase analysis of contrast-enhanced ultrasound in the diagnosis of patients with hyperplastic nodules with underlying liver cirrhosis[J]. Journal of Practical Hepatology, 2022, 25(2): 267-270.

参考文献

[1] Castaldo G, Calcagno G, Sibillo R, et al. Quantitative analysis of aldolase a mRNA in liver discriminates between hepatocellular carcinoma and cirrhosis. Clin Chem, 2000, 46(7):901-906.
[2] Tzartzeva K, Obi J, Rich NE, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis, Gastroenterology, 2018, 154(6):1706-1718.
[3] Yasir S, Chen ZE, Said S, et al. Biopsies of hepatocellular carcinoma with no reticulin loss: an important diagnostic pitfall. Hum Pathol, 2021,107(6):20-28.
[4] 丁建民, 周燕, 王凤梅,等. 超声造影联合普美显磁共振对肝硬化背景下微小肝细胞肝癌的诊断研究. 中华超声影像学杂志, 2019, 28(11):964-970.
[5] 陈姣姣, 何年安, 房静, 等. 常规超声和超声造影检查诊断肝内胆管细胞癌. 实用肝脏病杂志, 2021, 24(2):272-275.
[6] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2019年版).实用肝脏病杂志,2020,23(1)S9-32.
[7] Claudon M, Dietrich CF, Choi BI, et al. Guidelines and good clinical practice recommendations forcontrast enhanced ultrasound (CEUS) in the liver-update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol, 2013, 39(2):187-210.
[8] He E, Balkwill A, Liu B, et al. Comparison of risk factors for cirrhosis and hepatocellular carcinoma:a large prospective study of UK women. J Hepatol, 2020, 73(5):805-812.
[9] Jamialahmadi O, Bianco C , Pelusi S, et al. Population attributable risk of cirrhosis and hepatocellular carcinoma due to genetic predisposition to fatty liver disease. J Hepatol, 2021, 18(6):1211-1218.
[10] El-Ali AM, Davis JC, Cickelli JM, et al. Contrast-enhanced ultrasound of liver lesions in children. Pediatr Radiol, 2019, 49(11):1422-1432.
[11] Mücke VT, Fitting D, Dultz G,et al. Application of contrast-enhanced ultrasound to detect hepatic hydrothorax in patients with liver cirrhosis. Ultraschall Med, 2020, 16(8):1189-1193.
[12] Nmm A, Aam A, Klm B, et al. Comparison of dynamic contrast-enhanced magnetic resonance imaging and contrast-enhanced ultrasound for evaluation of the effects of sorafenib in a rat model of hepatocellular carcinoma. Magn Reson Imaging, 2019, 57(11):156-164.
[13] Fu R, Qiu T, Ling W, et al. Nodular focal fat sparing of liver mimicking hepatocellular carcinoma in contrast-enhanced ultrasound: a case report. Medicine, 2019, 98(22):e15431.
[14] 高莉, 高屹, 尹秋萍. CT灌注成像联合彩色多普勒超声造影辨别肝脏结节性病变性质临床价值探讨. 实用肝脏病杂志, 2020, 23(1):112-115.
[15] Wang Y, Jia L, Wang X, et al. Diagnostic performance of 2-D shear wave elastography for differentiation of hepatoblastoma and hepatic hemangioma in children under 3 years of age. Ultrasound Med Biol, 2019, 45(6):1397-1406.
[16] Yano Y, Yoshimatsu K, Yokomizo H, et al. Enhancement of the marginal area in colorectal cancer liver metastasis on computed tomography correlates with microvessel densityand clinicopathological factors. Anticancer Res, 2019, 39(3):1301-1308.
[17] Lsb A, Skm A, Clad A, et al. Two-dimensional parametric parenchymal blood flow in transarterial chemoembolisation for hepatocellular carcinoma: perfusion change quantification and tumour response prediction at 3 months post-intervention. Clin Radiol, 2020, 76(2):e27-e33.