超声造影诊断肝脏占位性病变良恶性效能分析*

doi:10.3969/j.issn.1672-5069.2024.04.029

摘要/Abstract

摘要： 目的探讨超声造影(CEUS)诊断肝脏占位性病变良恶性的效能。方法 2020年1月～2023年1月收治的97例肝脏占位性病变患者,接受肝穿刺活检及彩色多普勒超声和CEUS检查,采用Tom Tec Sono Liver CAP 软件分析CEUS数据,采用受试者工作曲线(ROC)分析超声诊断肝脏占位性病变良恶性的效能。结果经病理学检查,在97肝脏占位性病变患者中,诊断恶性病变41例(胆管细胞癌5例、转移性肝癌10例、肝细胞癌26例)和良性病变56例(局灶性结节性增生29例和炎性假瘤27例);恶性病变动脉期局部血流量为(63.9±12.1)mL/min,显著大于良性病变【(42.7±8.9)mL/min,P<0.05】,延迟期局部血流量为(17.6±2.4)mL/min,显著小于良性病变【(19.0±2.7)mL/min,P<0.05】;恶性病变始峰时间、达峰时间、上升时间和通过时间分别为(11.5±2.1)s、(34.1±6.9)s、(25.8±4.3)s和(110.5±20.7)s,显著短于良性病变【分别为(14.1±2.3)s、(45.9±6.2)s、(37.6±5.8)s和(149.3±24.1)s,P<0.05】,而灌注指数显著大于良性病变【(141.2±20.0)对(89.7±18.9),P<0.05】;二维超声诊断良恶性肝脏局灶性病变的灵敏度为82.9%,特异度为78.4%,准确度为78.4%,阳性预测值为70.8%,阴性预测值为85.7%,而CEUS诊断良恶性肝脏局灶性病变的灵敏度为80.5%,特异度为82.1%,准确度为81.4%,阳性预测值为76.7%,阴性预测值为85.2%。结论 CEUS诊断肝脏占位性病变良恶性具有较高的应用价值,可协助临床决策。

关键词: 肝脏占位性病变, 原发性肝癌, 超声造影, 诊断

Abstract: Objective The aim of this study was to investigate the qualitative diagnosis of hepatic space-occupying lesions (SOL) by contrast-enhanced ultrasonography (CEUS). Methods 97 patients with hepatic SOL were encountered in our hospital between January 2020 and January 2023, and all underwent fine needle aspiration biopsies, and conventional ultrasonography and CEUS. The CEUS data were analyzed by Tom Tec Sono Liver CAP software and the area under receiver operating characteristic curve (AUC) was applied to evaluate the diagnostic efficacy. Results The pathological examination showed that there were malignant lesions in 41 patients, including cholangiocarcinoma in 5 cases, metastatic liver cancer in 10 cases and hepatocellular carcinoma in 26 cases, and benign lesions in 56 patients, including focal nodular hyperplasia in 29 cases and inflammatory pseudotumors in 27 cases; the regional blood flow (rBF) at arterial phase in malignant foci was (63.9±12.1)mL/min, much greater than [(42.7±8.9)mL/min, P<0.05], while the rBF at delayed phase was (17.6±2.4)mL/min, much smaller than [(19.0±2.7)mL/min, P<0.05] in benign foci; the initial peak time, peak time, ascent time and passage time in malignant lesions were(11.5±2.1)s, (34.1±6.9)s, (25.8±4.3)s and (110.5±20.7)s, significantly shorter than [(14.1±2.3)s, (45.9±6.2)s, (37.6±5.8)s and (149.3±24.1)s, respectively, P<0.05], while the perfusion index was(141.2±20.0), much greater than [(89.7±18.9), P<0.05] in benign lesions; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value by conventional ultrasonography in differentiating benign from malignant lesions were 82.9%, 78.4%, 78.4%, 70.8% and 85.7%, while they were 80.5%, 82.1%, 81.4%, 76.7% and 85.2% by CEUS. Conclusion The CEUS has a high diagnostic performance in qualitative diagnosis in patients with hepatic SOL, which might help clinicians make an appropriate measure to deal with it.

Key words: Space-occupying liver lesions, Hepatoma, Contrast-enhanced ultrasonography, Diagnosis

王正华, 王明达, 张晓谦. 超声造影诊断肝脏占位性病变良恶性效能分析^*[J]. 实用肝脏病杂志, 2024, 27(4): 607-610.

Wang Zhenghua, Wang Mingda, Zhang Xiaoqian. Qualitative diagnosis of hepatic space-occupying lesions by contrast-enhanced ultrasonography[J]. Journal of Practical Hepatology, 2024, 27(4): 607-610.

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超声造影诊断肝脏占位性病变良恶性效能分析^*

Qualitative diagnosis of hepatic space-occupying lesions by contrast-enhanced ultrasonography

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