超声造影与增强螺旋CT诊断肝细胞癌的对比研究  

Comparison of contrast-enhanced ultrasound and contrast-enhanced helical computed tomography in diagnosis of hepatocellular carcinoma

作　　者：时静祥[1] 王毅军[1] 经翔[1] 王凤梅[1] 丁建民[1] 张翔[1] 张勤[1] SHI Jing-xiang;WANG Yi-jun;JING Xiang;WANG Feng-mei;DING Jian-min;ZHANG Xiang;ZHANG Qin(Tianjin Third Central Hospital, Key Laboratory of Artificial Cell, Institute of Hepatobiliary Disease, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China)

机构地区：[1]天津市第三中心医院,天津市人工细胞重点实验室,天津市肝胆疾病研究所,卫生部人工细胞工程技术研究中心,300170

出　　处：《天津医药》2017年第6期643-647,共5页Tianjin Medical Journal

基　　金：天津市卫生局科技基金项目(2013KY03;2014KR04)

摘　　要：目的比较超声造影(CEUS)与增强螺旋CT(CECT)对肝硬化背景下肝细胞癌(HCC)的诊断效能。方法对207例241个乙肝肝硬化背景下肝脏局灶性病变进行CEUS和CECT检查,以病理结果为"金标准",将两种检查方法的诊断结果与病理结果进行对比,诊断差异性评价采用McNemar检验,一致性评价采用Kappa检验。结果(1)病理结果显示,113个≤2 cm的病灶中,HCC病灶63个,良性病变50个。CEUS、CECT对比"金标准"McNemar检验的差别均无统计学意义(P分别为0.824、0.082),Kappa检验CEUS、CECT与"金标准"结果一致性一般(Kappa值分别为0.643、0.421);CEUS诊断HCC的敏感度、特异度、阳性预测值、阴性预测值和准确度均高于CECT。在显示动脉期血供方面,CEUS增强显示率高于CECT[87.30%(55/63)vs.69.84%(44/63),χ~2=5.704,P=0.017]。(2)病理结果显示,128个>2 cm的病灶中,HCC病灶77个,良性病变51个。CEUS、CECT对比"金标准"McNemar检验的差别均无统计学意义(P分别为0.481、0.167),Kappa检验CEUS、CECT与"金标准"结果一致性一般(Kappa值分别为0.710、0.697);两者诊断HCC的敏感度、特异度、阳性预测值、阴性预测值和准确度差异不大。在显示动脉期血供方面,CEUS增强显示率与CECT差异无统计学意义[89.61%(69/77)vs.85.71%(66/77),χ~2=0.540,P=0.462]。结论对于直径≤2 cm的HCC,CEUS诊断的效果优于CECT;对于直径>2 cm的HCC而言,两者的诊断能力是相似的。Objective To compare the diagnostic value of contrast-enhanced ultrasound(CEUS)and contrastenhancedhelical computed tomography(CECT)for hepatocellular carcinoma(HCC)with liver cirrhosis.Methods Twohundreds and forty-one focal liver lesions in207patients with Hepatitis B virus(HBV)cirrhosis were detected with CEUSand CECT,respectively.Pathological results were used as"gold standard"to compare the two methods.Diagnostic results ofthe two methods were compared with pathological results.Differences were assessed using the McNemar test,and the Kappatest was used for consistency evaluation.Results(1)For113liver lesions that were≤2cm,the number of HCC lesionswas63,and the number of benign lesions was50.There were no significant differences in results of CEUS and CECTcompared with that of the"gold standard"of McNemar test results(P=0.824,P=0.082).Consistency of the Kappa testresults of CEUS and CECT in comparison with the"gold standard"was general(Kappa=0.643,Kappa=0.421).Thesensitivity,specificity,positive predictive value,negative predictive value and accuracy of HCC diagnosed by CEUS werehigher than those of CECT.The rate of arterial enhancement was better for CEUS[87.30%(55/63)]than that for CECT[69.84%(44/63),χ2=5.704,P=0.017].(2)For128liver lesions that were>2cm,the number of HCC lesions was77,andthe number of benign lesions was51.There were no significant differences in the diagnostic results between McNemar testand CEUS and CECT tests(P=0.481,P=0.167).Consistency of the Kappa test results of CEUS and CECT and"goldstandard"was general(Kappa=0.710,Kappa=0.697).The sensitivity,specificity,positive predictive value,negativepredictive value and accuracy of HCC were not different between two diagnostic methods.The rate of arterial enhancementwas89.61%(69/77)for CEUS and85.71%(66/77)for CECT,and there was no significant difference between the two groups(χ2=0.540,P=0.462).Conclusion For HCC≤2cm,the diagnostic performance of CEUS is better than that of CECT.For HCC>2cm,the diagnostic performance is similar for the t

关 键 词：癌 肝细胞 肝硬化 超声造影 增强螺旋CT 

分 类 号：R445.1[医药卫生—影像医学与核医学]