超声造影、剪切波弹性成像和增强CT检查诊断肝细胞癌价值分析*

doi:10.3969/j.issn.1672-5069.2023.03.027

摘要/Abstract

摘要： 目的探讨超声造影(CEUS)、超声剪切波弹性成像(SWE)和增强CT检查诊断肝占位病变性质的价值。方法 2020年6月～2022年6月我院诊治的肝占位性病变患者128例,术前均行CEUS、SWE【检测杨氏模量最大值(Emax)】和CT检查,取手术后组织或穿刺细胞学检查,作出病理学诊断。结果在本组128例肝占位性病变患者中,病理学检查诊断肝细胞癌(HCC)72例,良性结节56例;两组CEUS检查动脉期、门脉期和延迟期增强程度具有显著性差异(P＜0.05),79.2%HCC组呈“快进快出”表现,81.9%动脉期呈高增强, 62.5%门脉期呈低增强,79.2%延迟期呈低增强,80.4%良性病变呈“慢进慢出”表现,44.6%动脉期、76.8%门脉期和80.4%延迟期为等增强。CEUS诊断的敏感性为83.3%,特异性为87.5%,准确性为85.2%,阳性预测值为89.6%,阴性预测值为80.3%;HCC组Emax为(42.5±7.1)kPa,显著高于良性组【(36.3±6.5)kPa, t=5.064,P＜0.01】。以Emax≥39.6 kPa为诊断恶性病变的截断点,SWE诊断的敏感性为79.2%,特异性为76.8%,准确性为78.9%,阳性预测值为81.4%,阴性预测值为74.1%;两组病灶增强CT检查动脉期、门脉期和延迟期增强程度具有显著性差异(P＜0.05),77.8%HCC病灶呈“快进快出”表现,83.3%动脉期呈高增强,59.7%门脉期呈低增强,77.8%延迟期呈低增强。82.1%良性病变呈“慢进慢出”表现,42.9%动脉期、78.6%门脉期和82.1%延迟期均为等增强。CT诊断的敏感性为77.8%,特异性为87.5%,准确性为82.0%,阳性预测值为88.9%,阴性预测值为75.4%。结论 CT和CEUS都是临床诊断HCC的重要手段,开展SWE检查可以在特殊情况下提供更多的诊断证据,值得探讨。

关键词: 肝细胞癌, 肝脏增生结节, 超声造影, 剪切波弹性成像, 增强CT, 诊断

Abstract: Objective The aim of this study was to investigate the diagnostic efficacy of liver contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE) and contrast-enhanced CT scan in patients with occupying lesions in liver (OLL). Methods 128 patients with OLL were encountered in our hospital between June 2020 and June 2022, and all underwent CEUS, SWE and CT scan at presentation. The histopathological and/or cytology examination were performed after operation. Results Out of the 128 patients with OLL, the pathological examination showed hepatocellular carcinoma (HCC) in 72 cases and benign lesions in 56 cases; there were obvious differences as respect to the enhancement patterns in arterial, portal and delayed phases between malignant and benign lesions (P＜0.05). 79.2% HCC presented with “fast in and fast out”, with 81.9% of increased enhancement at arterial phase, 62.5% of low enhancement at portal phase and 79.2% of low enhancement at delayed phase, while 80.4% benign lesions showed "slow in and slow out", with 44.6%, 76.8% and 80.4% of equal enhancement at arterial, portal and delayed phases. The diagnostic sensitivity (Se), specificity (Sp) and accuracy (Ac) by CEUS detection were 83.3%, 87.5% and 85.2%; the Young's modulus (Emax) in malignant lesions was (42.5±7.1)kPa, much higher than [(36.3±6.5)kPa, t=5.064, P＜0.01] in benign lesions. When the Emax≥39.6 kPa was set as the cut-off-value, the Se, Sp and Ac by SWE were 79.2%, 76.8% and 78.9%; 77.8%HCC presented as “fast in and fast out” at contrast-enhanced CT scan, with 83.3% of intensified enhancement at arterial phase, 59.7% of low enhancement at portal phase and 77.8% of low enhancement at delayed phase, while 82.1% of benign lesions presented with "slow in and slow out", with 42.9%, 78.6% and 82.1% of equal enhancement at arterial, portal and delayed phases. The Se, Sp and Ac by CT scan were 77.8%, 87.5% and 82.0%. Conclusion The CEUS and CT scan are both important measures for the diagnosis of patients with HCC, and the SWE might be an alternative approach for auxiliary diagnosis.

Key words: Hepatoma, Occupying lesions in liver, Contrast-enhanced ultrasonography, Shear wave elastography, Contrast-enhanced CT, Diagnosis

陈启全, 李晓婷, 杨勋祎, 王翔. 超声造影、剪切波弹性成像和增强CT检查诊断肝细胞癌价值分析^*[J]. 实用肝脏病杂志, 2023, 26(3): 408-411.

Chen Qiquan, Li Xiaoting, Yang Xunyi, et al.. Diagnostic efficacy of liver contrast-enhanced ultrasound, shear wave elastography and contrast-enhanced CT scan in patients with occupying lesions in liver[J]. Journal of Practical Hepatology, 2023, 26(3): 408-411.

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超声造影、剪切波弹性成像和增强CT检查诊断肝细胞癌价值分析^*

Diagnostic efficacy of liver contrast-enhanced ultrasound, shear wave elastography and contrast-enhanced CT scan in patients with occupying lesions in liver

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