肝硬化患者CT检测与肝穿刺活检病理诊断的对照分析  

Contrast analysis of CT Detection and Liver Biopsy Pathological Diagnosis of Liver Cirrhosis

作　　者：刘娴娟 蒋永芳[1] 马静[1] LIU Xianjuan;JIANG Yongfang;MA Jing(The Second Xiangya Hospital, Central South University, Hunan Changsha 423000, China)

机构地区：[1]中南大学湘雅二医院感染科

出　　处：《河北医学》2020年第3期455-458,共4页Hebei Medicine

基　　金：湖南省长沙市科技局基金资助项目，(编号:K1301012-31)

摘　　要：目的:以肝穿刺活检病理诊断为参照,评估CT检测肝硬化患者的诊断价值。方法:选取2018年3月至2019年3月我院收治的102例慢性乙型肝炎(乙肝)患者为对象,均行超声引导下肝穿刺活检、CT检测,以超声引导下肝穿刺活检检查结果为金标准,评估CT检测在肝硬化患者中的诊断价值。结果:以肝穿刺活检病理诊断结果为金标准,CT检测诊断肝硬化的灵敏度为89.23%(58/65)、特异度为78.38%(29/37)、准确度为85.29%(87/102),Kappa值为0.680;经肝穿刺活检病理确诊的65例肝硬化患者,CT检查提示47.69%患者肝脏形态异常(包含肝裂增宽及肝脏表面轮廓僵硬)、49.23%肝脏CT值降低且较同层面脾脏CT值低、40.00%肝左右叶比例异常、38.46%门静脉外径以及脾静脉外径增宽、63.08%脾肿大;CT检测对肝硬化患者肝功能分级诊断与肝穿刺活检病理诊断结果的整体符合率为87.69%;肝硬化良性结节CT征象无明显强化信号,但恶性结节CT检测表现为“快进快出”强化模式、病灶短期明显增大且数目增多。结论:CT检测对肝硬化早期诊断、病情程度评估及结节良恶性判断与肝穿刺活检病理诊断的一致性较好,其或可作为肝硬化诊断的有效手段。Objective:To evaluate the diagnostic value of CT detection in the diagnosis of patients with liver cirrhosis by referring to liver biopsypathological diagnosis.Methods:A total of 102 patients with chronic hepatitis B(CHB)admitted to the hospital from March 2018 to March 2019 were selected as the subjects.All of them underwent ultrasound-guided liver biopsy and CT detection.With the results of ultrasound-guided liver biopsy as the golden standard,the diagnostic value of CT detection in patients with liver cirrhosis was evaluated.Results:With the results of liver biopsy pathological diagnosis as the golden standard,the sensitivity,specificity,accuracy and Kappa value of CT detection for liver cirrhosis were 89.23%(58/65),78.38%(29/37),85.29%(87/102)and 0.680,respectively.Among the 65 patients with liver cirrhosis confirmed by liver biopsy pathology,CT found that 47.69%had abnormal liver morphology(including hepatic fissure widening and stiffness of liver surface contour),49.23%had decreased liver CT value lower than that of the same level spleen,40.00%had abnormal ratio of left to right liver lobe,38.46%had portal vein outer diameter and spleen vein outer diameter widening,and 63.08%had splenomegaly.The overall coincidence rate of CT detection with liver biopsy pathological diagnosis for grade of liver function was 87.69%.CT signs of benign nodules of liver cirrhosis showed no obvious enhancement signal,but CT of malignant nodules showed a fast-in and fast-out enhancement mode,and the lesions became larger and more in a short time.Conclusion:CT detection is consistent with liver biopsy pathological diagnosis for early diagnosis of liver cirrhosis,evaluation of the severity and differential diagnosis of benign and malignant nodules.It may be an effective means for the diagnosis of liver cirrhosis.

关 键 词：肝硬化 CT检测 肝穿刺活检 病理诊断 

分 类 号：R73[医药卫生—肿瘤]