超声及超声造影诊断HCC的局限性  

The Limitations of US and CEUS in Diagnosing HCC

作　　者：王延杰[1] 严昆[1] 高旭东 杨薇[1] 吴薇[1] 陈敏华[1] Wang Yanjie;Yan Kun;Gao Xudong;Yang Wei;Wu Wei;Chen Minhua(Key laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Ultrasound,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所超声科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京市100142

出　　处：《中国超声医学杂志》2020年第6期520-524,共5页Chinese Journal of Ultrasound in Medicine

基　　金：首都临床特色应用研究与成果推广(No.Z151100004015186)。

摘　　要：目的分析慢性肝炎、肝硬化合并肝外恶性肿瘤病史患者超声(US)、超声造影(CEUS)及两者联合诊断原发性肝细胞癌(HCC)的价值,并与穿刺活检病理对照分析。方法研究对象为406例有慢性肝炎、肝硬化病史的肝肿瘤患者,其中,50例既往有肝外恶性肿瘤病史,356例无肝外恶性肿瘤病史。所有患者均在获得病理诊断前进行US和CEUS检查并进行诊断,诊断结果与穿刺活检病理对照。结果50例肝肿瘤US、CEUS及两者联合诊断HCC结准确度分别为68%、78%及82%,三者之间无明显统计学差异(P>0.05)。50例肝肿瘤与356例肝肿瘤进行比较,US、CEUS及两者联合诊断HCC灵敏度、阳性预测值及准确度均有明显统计学差异(P<0.05),CEUS诊断HCC的阴性预测值有明显统计学差异(P<0.05)。结论慢性肝炎、肝硬化合并肝外恶性肿瘤病史患者肝肿瘤US、CEUS及两者联合诊断HCC有一定的局限性,治疗前穿刺活检对鉴别肝肿瘤性质有重要临床意义。Objective Analyze the diagnostic value of ultrasound(US),contrast enhanced ultrasound(CEUS)and combining the two methods in differentiating hepatocellular carcinoma(HCC)of patients with chronic hepatitis,hepatic cirrhosis and extrahepatic malignant tumors,which was compared with pathology of needle biopsy.Methods Four hundred and six cases of hepatic tumors were enrolled who would receive focal therapy.They all had a history of chronic hepatitis and hepatic cirrhosis.Fifty patients had extrahepatic malignant tumors while three hundred and fifty-six didn′t have.The 50 cases and 356 cases of hepatic tumors were diagnosed by US,CEUS and combining the two methods before obtaining pathology through needle biopsy.The diagnostic results were compared with pathology.Results Regarding the 50 cases of hepatic tumors,the diagnostic accuracy of US,CEUS and combining the two methods were 68%,78%and 82%,which had no significant difference(P>0.05).Comparing the 50 cases and 356 cases of hepatic tumors,the diagnostic sensitivity,positive predictive value and accuracy among US,CEUS and combining the two methods in diagnosing HCC had significant statistical differences(P<0.05).The diagnostic negative predictive value of CEUS had statistical difference(P<0.05).Conclusions US,CEUS and combining the two methods all have certain limitations in diagnosing HCC in patients with history of chronic hepatitis,hepatic cirrhosis and extrahepatic malignant tumors.Needle biopsy before treatment has a clinically significant value in identifying hepatic tumors.

关 键 词：穿刺活检 超声 超声造影 肝细胞癌 

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]