超声剪切波黏弹性技术在肝肿瘤良恶性鉴别中的初步临床应用  

Primary clinical application of shear wave elastography combined with shear wave dispersion in differentiating diagnosis of focal liver lesions

作　　者：张琪 董怡 杨道辉 于凌云 邱艺杰 王文平 Zhang Qi;Dong Yi;Yang Daohui;Yu Lingyun;Qiu Yijie;Wang Wenping(Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院超声科,上海200032 [2]上海市影像医学研究所,200032

出　　处：《中华超声影像学杂志》2019年第9期766-770,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81501471,81371577,81571676);上海市科委西医引导类项目(18411967200);上海市卫计委面上项目(201840215).

摘　　要：目的探讨超声剪切波弹性成像(shear wave elastography,SWE)和剪切波频散成像(shear wave dispersion,SWD)在术前诊断及鉴别肝肿瘤良恶性中的初步临床应用价值。。方法前瞻性收集2018年1-4月于我院就诊的83例拟手术的肝局灶性占位的患者。术前用超声剪切波黏弹性技术测量肝肿瘤内部及肿瘤周边2cm外的肝实质的黏弹性数值。术前在每个病灶内部及周边肝实质内选取两个感兴趣区,每个感兴趣区内分别测量13次黏弹性数据。以术后的最终病理结果为金标准,分析剪切波黏弹性在术前鉴别肝肿瘤良恶性中的价值。结果最终病理结果显示,在83例肝局灶性占位病变中,良性肿瘤有20例(包括肝局灶性结节性增生5例,肝血管瘤15例),恶性肿瘤有63例(包括原发性肝细胞肝癌51例,肝转移癌12例)。良性肿瘤的SWE测量值显著低于恶性肿瘤[(9.94±8.22)kPa对(13.68±7.80)kPa,P<0.05]。良性肿瘤的SWD测量值也显著低于恶性肿瘤[(13.47±2.76)(m/s)/kHz对(15.00±3.82)(m/s)/kHz,P<0.05]。与恶性肿瘤相比,良性肿瘤与周边肝实质的剪切波黏弹性比值均较大(P<0.05)。肝良恶性肿瘤与周边肝实质的SWE比值分别为1.65(0.92,3.76)、1.03(0.38,2.05)(P<0.05)。肝良恶性肿瘤与周边肝实质的SWD比值分别为1.01(0.75,1.22)、0.88(0.54,1.14)(P<0.05)。结论超声剪切波黏弹性新技术凭借其敏感、简便、无创、可多次重复测量的优点,对术前鉴别肝肿瘤的良恶性具有潜在的临床应用价值。Objective To investigate the initial clinical value of shear wave elastography (SWE) combined with shear wave dispersion (SWD) in preoperatively differentiating diagnosis of focal liver lesions (FLLs). Methods Eighty-three patients diagnosed as FLLs were prospectively enrolled from January to April 2018 in Zhongshan Hospital of Fudan University. Measurements of SWD and SWE both inner FLLs and surrounding liver parenchyma 2 cm away from the board lines of lesions were performed. ROIs were placed within the lesions and surrounding parenchyma 2 cm away from the lesions. In each ROI, measurements were performed 13 times. Histopathological results after operation were regarded as gold standard, and the values of viscoelasticity in differentiating diagnosis of FLLs were analyzed. Results The final histopathological results showed that of all 83 cases, 20 cases were diagnosed as benign lesions (5 cases of focal nodular hyperplasia, 15 cases of hemangioma), and 63 cases as malignant lesions (12 cases of liver metastases, 51 cases of hepatocellular carcinoma). The SWE of benign lesions and malignant lesions were (9.94±8.22)kPa, and (13.68±7.80)kPa(P<0.05). The SWD of benign lesions and malignant lesions were (13.47±2.76)(m/s)/kHz, and (15.00±3.82)(m/s)/kHz(P<0.05). The SWE ratio and SWD ratio of benign lesions to surrounding liver parenchyma were higher than those of malignant lesions(all P<0.05). The SWE ratio of benign and malignant lesions were 2.60±2.65, and 1.40±1.40, respectively (P<0.05). The SWD ratio of benign and malignant lesions were 0.92±0.44, and 0.80±0.51, respectively(P<0.05). Conclusions With the advantages of effectiveness, convenience, non-invasiveness and repeatability, combined measurement of SWE and SWD has a potential value in differentiating diagnosis of liver lesions.

关 键 词：剪切波弹性成像 剪切波频散成像 黏弹性 肝肿瘤 鉴别诊断 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]