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

Abstract

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

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.

References

[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.

Clinical value of perfusion phase analysis of contrast-enhanced ultrasound in the diagnosis of patients with hyperplastic nodules with underlying liver cirrhosis

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Zheng Xiaoqin, Xu Hui, Li Li, et al. Clinical features of patients with familial primary biliary cirrhosis [J]. Journal of Practical Hepatology, 2022, 25(2): 207-210.
[2]	Zeng Yi, Li Guo, Li Hongcui, et al. Efficacy of ursodeoxycholic acid in the treatment of patients with primary biliary cholangitis and cirrhosis and its effect on serum Nrf2 and HO-1 levels [J]. Journal of Practical Hepatology, 2022, 25(2): 211-214.
[3]	Hao Yuting, Lin Jie, Qin Jie. Clinical implication of serum aquaporin-8 and aquaporin-9 in patients with hepatitis B-induced liver cirrhosis receiving long-term entecavir therapy [J]. Journal of Practical Hepatology, 2022, 25(2): 243-246.
[4]	Wang Benxian, Li Wei, Li Dongsheng, et al. Cell-free and concentrated ascites reinfusion therapy for patients with decompensated cirrhosis [J]. Journal of Practical Hepatology, 2022, 25(2): 247-250.
[5]	Zhang Yu, Liu Fuquan. Precision technique and rational shunt in transjugular intrahepatic portosystemic shunt [J]. Journal of Practical Hepatology, 2022, 25(1): 5-8.
[6]	Chen Jing, Zhu Yueyong. Non-invasive diagnosis of portal hypertension in patients with liver cirrhosis: serum markers or imaging? [J]. Journal of Practical Hepatology, 2022, 25(1): 9-12.
[7]	Xu Yan,Yu Bingnan,Wu Jian. Coincidence of autoimmune thyroid diseases in patients with autoimmune hepatitis and primary biliary cirrhosis [J]. Journal of Practical Hepatology, 2022, 25(1): 42-45.
[8]	Zhou Xiaoyong, Bai Yangqiu, Yang Hui, et al. Changes of serum thyroid hormone levels andprevalence of anti-thyroid antibodies in patients with primary biliary cholangitis [J]. Journal of Practical Hepatology, 2022, 25(1): 46-49.
[9]	Li Yanle, Liu Xiaoyu, Yao Jianning, et al. Serum ammonia level changes and its correlation to cognitive impairment in patients with hepatitis B cirrhosis and hepatic encephalopathy [J]. Journal of Practical Hepatology, 2022, 25(1): 74-78.
[10]	Wang Jing,Bi Ning,Fang Liang,et al. Correlation of blood CD64 index to intestinal mucosal barrier functions in patients with hepatitis B cirrhosis and spontaneous bacterial peritonitis [J]. Journal of Practical Hepatology, 2022, 25(1): 79-82.
[11]	Xiao Qian,Zhou Zhan,Hu Xiaoli. Clinical application of contrast-enhanced ultrasound parameters in the quantitative diagnosis of patients with hepatocellular carcinoma [J]. Journal of Practical Hepatology, 2022, 25(1): 92-95.
[12]	Wu Ling, Li Feng. Administration of non-selective beta-blockers in treatment of patients with liver cirrhosis and portal hypertension [J]. Journal of Practical Hepatology, 2022, 25(1): 144-147.
[13]	Wu Xiaofeng, Huang Yi, Yang Ruxing,et al. Blood serine protease inhibitor A1 gene polymorphism in patients with primary biliary cirrhosis [J]. Journal of Practical Hepatology, 2021, 24(6): 855-858.
[14]	Shi Cuicui, Liu Yanjun, Zhang Ruinan, et al. Dyslipidemia in patients with liver cirrhosis [J]. Journal of Practical Hepatology, 2021, 24(6): 859-862.
[15]	Liu Mei, Shi Yonghong, Ying Juan, et al. Prevalence of nosocomial infection and resistance of pathogens in patients with decompensated liver cirrhosis [J]. Journal of Practical Hepatology, 2021, 24(6): 863-866.