超声造影时间-强度曲线诊断肝硬化患者肝内小结节病灶价值研究*

doi:10.3969/j.issn.1672-5069.2022.06.026

摘要/Abstract

摘要： 目的探讨应用超声造影(CEUS)时间-强度曲线定性诊断肝硬化伴肝小结节病灶的价值。方法 2019年2月～2020年12月我院诊治肝硬化伴有肝内结节患者108例,均接受穿刺或手术组织病理学检查,术前接受CEUS检查,由软件获得时间-强度曲线上峰值强度(PI) 、上升时间(RT)和达峰时间(PT)等参数。参照CEUS时间-强度曲线诊断恶性结节的标准诊断,应用MedCal 15.2软件绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评价CEUS时间-强度曲线诊断肝硬化伴肝小结节病灶的价值。结果在108例肝硬化伴肝小结节病灶患者,经病理学检查诊断肝细胞癌43例,肝结节性再生性增生65例;恶性结节组织PI、RT和PT分别为(214.5±20.8)%、(17.6±3.2)s和(24.3±4.6)s,与良性结节组织【分别为(117.2±15.7)%、(38.1±6.9)s和(46.8±8.1)s,P<0.05】或病灶旁肝组织【分别为(115.9±16.1)%、(37.6±6.3)s和(47.4±8.4)s,P<0.05】比,差异显著;应用CEUS诊断恶性结节的灵敏度、特异度和准确性分别为72.1%、73.8%和73.1%,而应用CEUS时间-强度曲线诊断则分别提高到了97.7%、87.7%和91.7%。结论基于CEUS时间-强度曲线参数诊断肝硬化伴肝内小结节病灶的准确率更高,可为临床诊断提供较为可靠的影像学依据。

关键词: 肝细胞癌, 肝硬化, 肝内结节, 超声造影, 时间-强度曲线, 诊断

Abstract: Objective The aim of this study was to explore the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) time-intensity curve in patients with liver cirrhosis (LC) and intrahepatic nodules. Methods A total of 108 patients with LC and intrahepatic nodules were encountered in our hospital between February 2019 and December 2020, and all underwent liver punctures or operation for histopathological diagnosis. All patients with LC received CEUS and the peak intensity (PI), rise time (RT) and peak time (PT) were obtained based on the time-intensity curve of CEUS. The malignant nodules diagnosed by time-intensity curve of CEUS was defined referred to literature. The area under receiver operating characteristic curve (AUC) by MedCal 15.2 software was applied to evaluate the diagnostic efficacy of parameters. Results Out of the 108 patients with LC and intrahepatic nodules, the histopathological examination showed hepatocellular carcinoma in 43 cases, and benign nodules in 65 cases; the PI, RT and PT in malignant foci were(214.5±20.8)%, (17.6±3.2)s and (24.3±4.6)s, significantly different as compared to [(117.2±15.7)%,(38.1±6.9)s and (46.8±8.1)s, respectively, P<0.05] in benign nodules or [(115.9±16.1)%, (37.6±6.3)s and (47.4±8.4)s, respectively, P<0.05] in adjacent liver tissues; the sensitivity, specificity and accuracy by CEUS in diagnose malignant nodules were 72.1%, 73.8% and 73.1%, all of them were raised to 97.7%, 87.7% and 91.7% by parameters based on the time-intensity curve of CEUS. Conclusion The diagnosing accuracy of time-intensity curve of CEUS in patients with LC and intrahepatic nodules is efficacious, which might help the clinicians make an appropriate decision for patients and improve the outcomes.

Key words: Hepatoma, Liver cirrhosis, Intrahepatic nodules, Contrast-enhanced ultrasound, Time-intensity curve, Diagnosis

张耀辉, 郑章增, 高星, 张亚利. 超声造影时间-强度曲线诊断肝硬化患者肝内小结节病灶价值研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 861-864.

Zhang Yaohui, Zheng Zhangzeng, Gao Xing, et al.. Contrast-enhanced ultrasound time-intensity curve in assessment of liver nodules in cirrhotic patients[J]. Journal of Practical Hepatology, 2022, 25(6): 861-864.

参考文献

[1] Inchingolo R, Faletti R, Grazioli L, et al. MR with Gd-EOB-DTPA in assessment of liver nodules in cirrhotic patients. World J Hepatol, 2018, 10(7):462-473.
[2] Kim HL, An J, Park JA, et al. Magnetic resonance imaging is cost-effective for hepatocellular carcinoma surveillance in high-risk patients with cirrhosis. Hepatology, 2019, 69(4):1599-1613.
[3] Corvino A, Sandomenico F, Setola SV, et al. Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art. J Ultrasound, 2019, 22(3):251-259.
[4] Walczyk J, Sowa-Staszczak A. Diagnostic imaging of gastrointestinal neuroendocrine neoplasms with a focus on ultrasound. J Ultrason,2019, 19(78):228-235.
[5] Beckmann S, Simanowski JH. Update in contrast-enhanced ultrasound. Visc Med, 2020, 36(6):476-486.
[6] Trinci M, Piccolo CL, Ferrari R, et al. Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma. J Ultrasound, 2019, 22(1):27-40.
[7] 中华医学会肝病学分会. 肝硬化诊治指南.实用肝脏病杂志,2019,22(6):770-792.
[8] Jiang HY, Chen J, Xia CC, et al. Noninvasive imaging of hepatocellular carcinoma: From diagnosis to prognosis. World J Gastroenterol, 2018, 24(22):2348-2362.
[9] Horvat N, Monti S, Oliveira BC, et al. State of the art in magnetic resonance imaging of hepatocellular carcinoma. Radiol Oncol, 2018, 52(4):353-364.
[10] Li L, Hu Y, Han J, et al. Clinical application of liver imaging reporting and data system for characterizing liver neoplasms: A meta-analysis. Diagnostics, 2021, 11(2):323-326.
[11] 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.
[12] Johnston MP, Khakoo SI. Immunotherapy for hepatocellular carcinoma: Current and future. World J Gastroenterol, 2019, 25(24):2977-2989.
[13] 张菊珍, 涂海斌, 林健玲. 超声造影对肝细胞癌微血管侵犯的预测价值. 中华肝胆外科杂志, 2019, 25(1):30-33.
[14] Negrao de Figueiredo G, Muller-Peltzer K, Schwarze V, et al. Ultrasound and contrast enhanced ultrasound imaging in the diagnosis of acute aortic pathologies. Vasa, 2019, 48(1):17-22.
[15] Nguyen T, Davidson BP. Contrast enhanced ultrasound perfusion imaging in skeletal muscle. J Cardiovasc Imaging, 2019, 27(3):163-177.
[16] Rafailidis V, Li X, Sidhu PS, et al. Contrast imaging ultrasound for the detection and characterization of carotid vulnerable plaque. Cardiovasc Diagn Ther, 2020, 10(4):965-981.
[17] Corvino A, Sandomenico F, Setola SV, et al. Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art. J Ultrasound, 2019, 22(3):251-259.
[18] Maruyama H, Kato N. Advances in ultrasound diagnosis in chronic liver diseases. Clin Mol Hepatol, 2019, 25(2):160-167.
[19] Sbeit W, Kadah A, Mari A, et al. A comprehensive narrative review on the evolving role of endoscopic ultrasound in focal solid liver lesions diagnosis and management. Diagnostics, 2020, 10(9):688-691.
[20] 乔志忠. 超声造影定量分析鉴别肝脏局灶性结节性增生与原发性肝癌初步探讨. 实用肝脏病杂志, 2019, 22(3):421-424.
[21] Tana C, Schiavone C, Ticinesi A, et al. Ultrasound imaging of abdominal sarcoidosis: State of the art. World J Clin Cases, 2019, 7(7):809-818.
[22] Walczyk J, Sowa-Staszczak A. Diagnostic imaging of gastrointestinal neuroendocrine neoplasms with a focus on ultrasound. J Ultrason, 2019, 19(78):228-235.
[23] Lorentzen T, Nolsoe CP. The role of US contrast agents in US-guided biopsy of focal liver lesions: A pictorial review. Ultrasound Int Open, 2019, 5(1):11-19.
[24] 刘潇, 何年安, 叶显俊, 等. 超声造影对肝细胞癌与肝转移癌的鉴别诊断价值分析. 实用肝脏病杂志, 2020, 23(1):94-97.

超声造影时间-强度曲线诊断肝硬化患者肝内小结节病灶价值研究^*

Contrast-enhanced ultrasound time-intensity curve in assessment of liver nodules in cirrhotic patients

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	韩涛, 刘艳迪, 胡家轩. 肝病合并肾损伤临床诊治新进展[J]. 实用肝脏病杂志, 2022, 25(6): 761-763.
[2]	蒋莹莹, 丁惠国. 肝硬化并发急性肾损伤临床管理现状与挑战[J]. 实用肝脏病杂志, 2022, 25(6): 764-767.
[3]	韩芳, 李佳峥, 南月敏. 肝硬化并发急性肾损伤诊治进展[J]. 实用肝脏病杂志, 2022, 25(6): 768-771.
[4]	贺潇瑾, 李丹, 周青, 欧阳静, 田玉球, 谭英征. L02细胞乙型肝炎病毒X蛋白和SOCS-1基因水平研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 772-775.
[5]	蔡勇, 李璟, 欧琴. 2型糖尿病合并非酒精性脂肪性肝病患者血清网膜素、视黄醇结合蛋白4和Ⅰ型原胶原氨基端前肽水平及意义分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 800-803.
[6]	王玉梅, 袁向东, 刘玉玲, 赵子瑜. 提示肥胖症儿童/青少年存在非酒精性脂肪性肝炎的指标分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 808-811.
[7]	沈亦亮, 沈冬元, 陈永莹, 江凯, 朱逸明, 葛尚. 肝硬化患者肝内LR-3类结节恶变风险评估及预测模型的建立^*[J]. 实用肝脏病杂志, 2022, 25(6): 836-839.
[8]	徐超, 李兰, 罗东, 赵海云, 彭飞. TIPS术治疗的肝硬化并发EVB患者医院内死亡风险预测模型的构建与应用^*[J]. 实用肝脏病杂志, 2022, 25(6): 840-843.
[9]	林秀慧, 李南, 张娇珍, 符庆忠, 林秀华. 慢性HBV感染者外周血PNPLA3/PRKAA1基因多态性与肝硬化发生关系研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 844-847.
[10]	朱海艳, 范晓棠. 肝硬化并发门静脉血栓形成患者列线图预测模型分析及外部验证[J]. 实用肝脏病杂志, 2022, 25(6): 848-852.
[11]	孙静, 张伟伟, 马智勇, 代树本, 邓彦东. 经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 853-856.
[12]	李响, 张铁英, 张旭辉, 孟繁坤. 基于超声参数的半定量评分评估乙型肝炎肝硬化食管静脉曲张价值探讨^*[J]. 实用肝脏病杂志, 2022, 25(6): 857-860.
[13]	詹致远, 申洋, 王凡冰. 内镜下套扎术联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张首次出血患者短期疗效分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 865-868.
[14]	石青春, 潘立民, 布凡, 王永强, 关睿骞. 基于TCGA研究细胞坏死相关基因对肝细胞癌患者预后的影响^*[J]. 实用肝脏病杂志, 2022, 25(6): 869-872.
[15]	郑希彦, 杜飞, 林志群, 李瑞曦, 周正, 张广权, 周红, 何方平, 史宪杰. 肝细胞癌进展:代谢综合征相关危险因素研究[J]. 实用肝脏病杂志, 2022, 25(6): 877-880.