基于Kupffer细胞特异性摄取的超声造影在肝脏肿瘤性病变诊断中的应用价值  

Impact of contrast-enhanced ultrasound based on specific uptake of Kupffer cells in diagnosis of focal hepatic lesions

作　　者：李晨[1] 刘媛[1] 许静涌[2] 吴明晓[1] 徐光[1] 苏里亚[1] 郭发金[1] 陈剑[2] Li Chen;Liu Yuan;Xu Jingyong;Wu Mingxiao;Xu Guang;Su Liya;Guo Fajin;Chen Jian(Department of Sonography,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of General Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院超声诊断科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]北京医院普通外科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中华肝胆外科杂志》2020年第12期907-911,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨基于Kupffer细胞特异性摄取的超声造影在肝脏肿瘤性病变诊断中的临床应用价值。方法选取2019年12月至2020年1月北京医院肝胆胰外科连续入组的肝脏肿瘤性病变患者,行Sonazoid超声造影(S-CEUS),观察病变S-CEUS的血管相及Kupffer期特点。以病理检查为诊断"金标准",计算S-CEUS和CT在肝脏肿瘤性病变良恶性病理检查诊断中的准确率以及S-CEUS诊断的敏感度、特异度、阳性预测值、阴性预测值以及一致性(Kappa值)。结果共纳入31例有病理证实的肝脏肿瘤性病变患者,其中男性20例,女性11例,年龄(56.7±14.0)岁,体质量指数(24.9±4.1)kg/m2。31例患者中,经病理证实30个恶性病灶,12个良性病灶。S-CEUS诊断考虑32个恶性病灶,10个良性病灶,其中误诊或未明确诊断6个病灶,与病理检查符合率85.7%(36/42)。CT发现病灶38个,漏诊4个病灶,恶性病灶误诊2个,良性病灶误诊3个,与病理检查符合率78.6%(33/42)。S-CEUS对肝脏肿瘤性病变良恶性诊断准确率为90.5%(38/42),敏感度96.7%(29/30),特异度75.0%(9/12),阳性预测值90.6%(29/32),阴性预测值90.0%(9/10),Kappa值=0.754(χ^2=20.478,P<0.01)。结论相对于CT,S-CEUS对肝脏肿瘤性病变的诊断有较高的符合率,对于良恶性疾病的鉴别有较高的准确率。Objective To study the impact of contrast-enhanced ultrasound based on specific uptake of Kupffer cells in diagnosis of focal hepatic lesions.Methods Consecutive patients with histopathological diagnosed focal hepatic lesions treated in the Department of Hepatobiliary and Pancreatic Surgery,Beijing Hospital from December 2019 to January 2020 and who also underwent Sonazoid contrast-enhanced ultrasound(S-CEUS)to study the vascular phase and Kupffer stage characteristics were enrolled into this study.Using histopathological examination as the"gold standard"for diagnosis,S-CEUS was compared with CT in differentiating between benign and malignant lesions in diagnosis and consistency(Kappa value)in accuracy,sensitivity,specificity,and positive predictive value.Results There were 31 patients with histopathologically confirmed focal liver lesions,with 20 males and 11 females aged(56.7±14.0)years,and with a body mass index of(24.9±4.1)kg/m2.There were 30 malignant lesions and 12 benign lesions.S-CEUS diagnosed 32 malignant lesions and 10 benign lesions,with 6 lesions being misdiagnosed or not clearly diagnosed.The coincidence rate with histopathology was 85.7%(36/42).CT found 38 lesions,missed 4 lesions,misdiagnosed 2 malignant lesions,and misdiagnosed 3 benign lesions.The coincidence rate with histopathology was 78.6%(33/42).The diagnostic accuracy of S-CEUS for benign and malignant liver lesions was 90.5%(38/42),sensitivity 96.7%(29/30),specificity 75.0%(9/12),and positive predictive value 90.6%(29/32),negative predictive value 90.0%(9/10),with a Kappa value of 0.754(χ^2=20.478,P<0.01).Conclusions Compared with CT,S-CEUS was more consistently with histopathology in diagnosing focal liver lesions.S-CEUS had a higher accuracy in differentiating between benign and malignant lesions.

关 键 词：肝肿瘤 超声造影 SONAZOID 枯否细胞 

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]