超声造影联合声触诊组织量化技术鉴别肝血管瘤与肝细胞癌价值研究*

doi:10.3969/j.issn.1672-5069.2022.04.030

摘要/Abstract

摘要： 目的探讨使用超声造影(CEUS)联合超声声触诊组织量化技术(VTQ)鉴别肝血管瘤与肝细胞癌(HCC)的价值。方法 2018年4月～2021年4月我院诊治的肝内占位性病变患者93例,所有患者接受CEUS和VTQ检查,比较开始增强时间、增强峰值时间和峰值强度及VTQ检查的病灶内部剪切波速度(SWV)、周边组织SWV和病灶/周边组织SWV比值,应用ROC分析CEUS检查参数和SWV诊断HCC的效能。结果本组肝占位患者经CT、MRI或术后组织病理学检查,诊断肝血管瘤40例,肝细胞癌53例;肝细胞癌患者CEUS开始增强时间和增强峰值时间分别为(8.2±1.2)s和(16.7±3.3)s,显著短于肝血管瘤患者【分别为(15.9±5.0)s和(45.7±15.4)s,P＜0.05】;肝细胞癌患者病灶内部SWV、周边组织SWV和SWV比值分别为(2.7±0.9)、(2.0±0.8)和(1.8±0.7),显著大于肝血管瘤患者【分别为(1.5±0.4)、(1.4±0.6)和(1.1±0.3),P＜0.05】;经ROC分析,开始增强时间、增强峰值时间、病灶内部SWV、周边组织SWV和SWV比值诊断HCC的曲线下面积(AUC)分别为0.754、0.818、0.758、0.802和0.809,其敏感度分别为0.600、0.700、0.717、0.717和0.755,特异度分别为0.830、0.925、0.800、0.800和0.800;分别以开始增强时间≤12.080 s、增强峰值时间≤26.530 s、病灶内部SWV≥2.015 m/s、周边组织SWV≥1.920 m/s和SWV比值≥1.280为截断点,任一指标达标即诊断HCC,结果诊断HCC者48例,其敏感度为0.906,特异度为0.950,准确率为0.925,阳性预测值为0.960,阴性预测值为0.884。结论肝细胞癌与肝血管瘤CEUS和VTQ检查参数存在显著差异,籍此可为病灶的鉴别诊断提供帮助,具有很高的临床应用价值。

关键词: 肝细胞癌, 肝血管瘤, 超声造影, 声触诊组织量化技术, 诊断

Abstract: Objective The aim of this study was to evaluate the value of contrast ultrasonography (CEUS) and virtual touch tissue quantification (VTQ) in differentiating hepatic hemangioma from hepatocellular carcinoma (HCC). Methods 93 patients with intrahepatic space-occupying lesions were encountered in our hospital between April 2018 and April 2021, and all underwent CEUS and VTQ check-up. The CEUS parameters including start enhancement time, peak enhancement time and peak intensity, and the shear wave velocity (SWV) of intrahepatic foci, surrounding tissues and SWV ratio of foci/surrounding tissue obtained by VTQ were recorded. Thediagnostic efficacy was determined by ROC analysis. Results Out of our series, the hepatic hemangioma was found in 40 cases, and HCC in 53 cases based on CT/MRI scan or post-operational histopathological examination; the onset enhancement time and peak enhancement time in patients with HCC were (8.2±1.2) s and (16.7±3.3) s, significantly shorter than [(15.9±5.0) s and (45.7±15.4) s, respectively, P < 0.05] in patients with hepatic hemangioma; the SWV of hepatic foci, the SWV of surrounding tissues and SWV ratio in patients with HCC were (2.7±0.9), (2.0±0.8) and (1.8±0.7), significantly greater than [(1.5±0.4), (1.4±0.6) and (1.1±0.3), respectively, P＜0.05] in patients with hepatic hemangioma; the ROC analysis showed that the onset enhancement time, peak enhancement time, the SWV of hepatic foci, the SWV of surrounding tissues and SWV ratio all had some diagnostic efficacy with the AUC of 0.754, 0.818, 0.758, 0.802 and 0.809, respectively; we set the onset enhancement time ≤12.080 s, the peak enhancement time≤26.530 s, the SWV of hepatic foci≥2.015 m/s, the SWV of surrounding tissues ≥1.920 m/s and SWV ratio ≥1.280 as the optimal cut-off-value, the HCC was diagnosed in 48 cases when any one of the five parameter meeting, with sensitivity of 0.906, specificity of 0.950, accuracy of 0.925, positive predictive value of 0.960 and negative predictive value of 0.884. Conclusion There are significant differences in CEUS and VTQ results between HCC and hepatic hemangioma, by which the clinicians could make differentiation of benign and malignant intrahepatic lesions.

Key words: Hepatoma, Hepatic hemangioma, Contrast-enhanced ultrasound, Virtual touch tissue quantification, Diagnosis

王晶, 张洁, 赵静. 超声造影联合声触诊组织量化技术鉴别肝血管瘤与肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2022, 25(4): 575-578.

Wang Jing, Zhang Jie, Zhao Jing. Differentiation of hepatic hemangioma from hepatocellular carcinoma by contrast ultrasonography and virtual touch tissue quantification: An analysis of 93 cases[J]. Journal of Practical Hepatology, 2022, 25(4): 575-578.

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超声造影联合声触诊组织量化技术鉴别肝血管瘤与肝细胞癌价值研究^*

Differentiation of hepatic hemangioma from hepatocellular carcinoma by contrast ultrasonography and virtual touch tissue quantification: An analysis of 93 cases

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