超声造影与增强螺旋CT诊断肝硬化背景下≤2cm结节样病灶的比较研究  

Diagnosis of small focal nodular lesions in patients with liver cirrhosis： comparison between contrast-enhanced ultrasound and contrast-enhanced helical CT

作　　者：经翔[1] 刘艳丽[1] 张翔[2] 张传山[3] 高磊[1] 丁建民[1] 王彦冬[1] 赵新民[1] 

机构地区：[1]天津市第三中心医院超声科,300170 [2]天津市第三中心医院放射科,300170 [3]天津市第三中心医院病理科,300170

出　　处：《中华超声影像学杂志》2010年第1期16-20,共5页Chinese Journal of Ultrasonography

基　　金：天津市卫生局科技基金（06KZ16）

摘　　要：目的探讨超声造影（contrast—enhanced ultrasound，CEUS）与增强螺旋CT（contrast—enhanced helical computed tomography，CECT）对肝硬化背景下≤2cm结节样病灶的诊断效能。方法对72例81个肝硬化背景下常规超声检查可疑肝内小占位病变者（最大直径≤2cm）进行CEUS和CECT检查（两者间隔时间≤2周），将两种检查的术前诊断与病理结果进行比较分析，评估两种检查方法的诊断效能。结果81个病灶53个为肝细胞癌（HCC），26个增生结节，2个血管瘤。53个HCC中，CEUS51个（96．2％）病灶动脉期呈高增强，CECT41个（77．4％）病灶动脉期显示强化，CEUS与CECT在显示动脉期血供方面差异有统计学意义（P〈0．01）。以病灶动脉期呈高增强，门脉期或延迟期消退为低增强作为诊断HCC的标准，CEUS诊断小结节样病灶的敏感性、特异性、准确性分别为86．8％、82．1％、85．2％，CECT分别为73．6％、92．9％、80．2Vo（P〉0．05）。结论CEUS对≤2cm HCC动脉期血供的显示率高于CECT，CEUS对肝硬化背景下小结节样病灶的诊断能力与CECT相似。Objective To compare the diagnostic value of contrast-enhanced ultrasound （CEUS） and contrast-enhanced helical CT（CECT） for various small focal nodular lesions （42 cm） in patients with liver cirrhosis. Methods Eighty-one small hepatic space-occupying lesions in 72 patients with liver cirrhosis were detected with CEUS and CECT, respectively. The diagnostic performance was calculated by histological results obtained from biopsy or surgery,which was considered as the gold standard. Results Fifty-three of the 81 small nodules were hepatocellular carcinoma, 26 were regenerative nodules and 2 were hemangioma. On CEUS, 51 （96.2%,51/53） HCC were hypervascular during arterial phase. On CECT, 41 （77.4%,41/53） HCC were hypervascular （ P 〈 0.01 ）. Nodules which appeared by contrast enhancement during the arterial phase and contrast wash-out during the portal/late phase on CEUS or CECT were considered as HCC. The sensitivity, specificity and accuracy were 86.8% （46/53） ,82.1 %（23/28） ,and 85.2% （69/81） in CEUS,and 73.6% （39/53）, 92.9% （26/28） ,and 80.2 % （65/81） in CECT, respectively. Overall, there was no significant difference between CEUS and CECT in the diagnostic confidence for small hepatic nodules （ P 〉0. 05）. Conclusions CEUS is superior to CECT in the detection of arterial vascularization for small hepatocellular carcinoma with a diameter≤2cm. The ability of CEUS in the characterization of focal nodular lesions in cirrhotic livers is similar to that of CECT.

关 键 词：超声检查 微气泡 癌 肝细胞 肝硬化 体层摄影术 螺旋计算机 

分 类 号：R735.7[医药卫生—肿瘤]