超声造影评价肝脏恶性肿瘤高危人群的价值  

Application value of contrast-enhanced ultrasonography for assessing the high-risk population of hepatic malignant tumor

作　　者：吕盼盼[1] 李世岩[1] 徐海珊[1] 许立龙[1] 吕江红[1] 寿金朵[1] 赵博文[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,杭州310016

出　　处：《中华肿瘤杂志》2015年第7期545-548,共4页Chinese Journal of Oncology

基　　金：浙江省医药卫生科技计划（2014KYB128）

摘　　要：目的探讨超声造影（CEUS）评价肝脏恶性肿瘤（HMT）高危人群的价值。方法选择经临床评估为HMT高危人群的300例患者，接受CEUS检查。比较分析CEUS检出肝内恶性病灶和定性诊断的能力。结果在增强磁共振成像检出的119个恶性病灶（87例患者）中，CEUS检出112个，彩色多普勒超声检出95个，CEUS对肝内恶性病灶的检出率（94．1％）高于彩色多普勒超声（79．8％），差异有统计学意义（P〈0．01）。17．2％（15／87）的患者因增加了CEUS检查而检出彩色多普勒超声未发现的恶性病灶。经病理检查或长期随访明确诊断者177例，彩色多普勒超声和CEUS均能检出的病灶共215个，其中恶性病灶118个，良性病灶97个。CEUS判断肝内病灶良恶性的准确率为91．6％（197／215），彩色多普勒超声的准确率为59．1％（127／215），差异有统计学意义（P〈0．01）。CEUS提高了35．0％（62／177）患者的诊断准确率。对于首次发现肝内病灶的96例患者（105个病灶），与其最终临床诊断比较，CEUS诊断的符合率为92．4％（97／105）。CEUS在观察者之间和在观察者内部，定性诊断肝内实质性病灶均有较高的重复可靠性（Kappa值分别为0．866和0．934）。结论CEUS显著提高了HMT高危人群的肝内恶性病灶检出率和定性诊断准确率；对首发病灶CEUS具有较高的诊断符合率，有望成为HMT高危人群一种方便、准确、可靠的一线检查手段。Objective To investigate the clinical value of contrast-enhanced ultrasonography （CEUS） in assessing the high-risk population of hepatic malignant tumor （HMT）. Methods Three hundred patients with high-risk of HMT were enrolled and examined by CEUS. The clinical data of these patients were collected. A comparative analysis was performed to assess the ability of CEUS for detecting and characterizing lesions in the liver. Kappa test was used for assessing the intra-and inter-observer reliability of CEUS. Results In 87 enrolled patients with 119 malignant lesions detected by contrast-enhanced MRI, 112 lesions were detected by CEUS and 95 lesions were detected by unenhanced ultrasonography （US）. The detection rate of CEUS for HMT was significant higher than that of US （94.1% vs. 79.8%; P〈0.01）. More HMT lesions were detected by CEUS than by US in 17.2% patients. One hundred and seventy-seven patients with 215 lesions were confirmed by pathological diagnosis or long-time follow-up. There were 118 malignant and 97 benign lesions. The accuracy of CEUS for differential diagnosis of the liver lesions was 91.6% （ 197/ 215）, significantly higher than that by US （ 59.1%, 127/215） （ P〈0.01 ）. CEUS improved the accuracy for 35.0% （62/177） patients. For 96 patients with 105 lesions detected for the first time, the agreement of diagnosis by CEUS was 92.4% （97/105）. The reliability of CEUS was high （Kappainter =0.866; Kappaintra = 0.934）. Conclusions CEUS improves the detection rate and diagnostic accuracy rate of the HMT high-risk population, with a high agreement for diagnosing the new lesions. CEUS may be considered as a first-line method to assess the high-risk population of HMT conveniently, accurately and reliably.

关 键 词：超声检查 肝肿瘤 诊断 鉴别 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]