超微血管成像在肝脏局灶性病变中的应用价值  

Application of superb microvascular imaging in focal liver lesions

作　　者：杨凡 刘春伟[2] 忻晓洁 张晟 Yang Fan;Liu Chunwei;Xin Xiaojie;Zhang Sheng(National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy of Tianjin,Tianjin′s Clinical Research Center for Cancer,Department of Ultrasound Diagnosis and Treatment,Tianjin Medical University Cancer Institute and Hospital,Tianjin Medical University,Tianjin 300060,China;Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心天津医科大学肿瘤医院超声诊疗科,300060 [2]天津市胸科医院心内科,300222

出　　处：《中华肿瘤杂志》2021年第9期959-967,共9页Chinese Journal of Oncology

摘　　要：目的探讨超微血管成像(SMI)对肝脏局灶性病变(FLLs)微血管特征的检测能力,分析血管指数(VI)、微血管密度(MVD)和Ki-67水平的关系。方法收集2018年于天津医科大学肿瘤医院诊断为FLLs患者的影像学资料。166例FLLs患者分为非肝细胞癌(非HCC)组(96例)和HCC组(70例)。全组患者均行彩色多普勒血流成像(CDFI)和SMI检查,分析患者的Adler′s半定量分级(0~3级)和血管形态特征(a~f模式),采用受试者工作特征(ROC)曲线评估SMI和CDFI血流特点对HCC的检测能力,采用Pearson相关分析评价HCC组患者VI与MVD的相关性,采用Spearman相关分析评价VI与Ki-67的相关性。结果HCC组中,SMI检测出高级别血流(Adler′s半定量分级2~3级)50例,高于CDFI(22例,P=0.033)。HCC组中,SMI检测出富血供模式(e、f模式)52例,高于CDFI(18例,P<0.001)。非HCC组中,CDFI与SMI检测出血流特征差异无统计学意义(P=0.537)。HCC组中SMI检测富血供模式52例,高于非HCC组(14例,P<0.001)。以富血供模式作为HCC诊断标准时,SMI的ROC曲线下面积为0.760(灵敏度为74.3%,特异度为85.4%),SMI富血供模式对HCC的诊断效果最佳。HCC组中,VI与MVD和Ki-67水平呈正相关(r分别为0.698和0.669,均P<0.05)。结论SMI对HCC微血管特征的检测能力优于CDFI,HCC较非HCC具有更多的富血供模式;在HCC中,VI与MVD和Ki-67表达水平呈正相关。Objective To investigate the ability of superb-microvascular imaging(SMI)to detect microvascular characteristics of focal liver lesions(FLLs)and analyze the relationship between vascular index(VI)and microvascular density(MVD)and Ki-67 levels.Methods The imaging data of patients diagnosed as FLLs at Tianjin Medical University Cancer Hospital in 2018 were collected.A total of 166 FLLs patients were divided into non-hepatocellular liver cancer(non-HCC group,96)and HCC group(70),respectively.The whole group of patients were subjected to color Doppler blood flow imaging(CDFI)and SMI examination.The patient′s Adler′s semi-quantitative grading(0 to 3 levels)and vascular morphological characteristics(a-f type)were analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the detection ability of HCC with SMI and CDFI blood flow characteristics,The Pearson correlation analysis was used to evaluate the correlation between HCC patients VI and MVD and the Spearman correlation analysis was used to evaluate the correlation between VI and Ki-67.Results In HCC group,SMI detected 50 cases of high-level blood flow(Adler′s semi-quantitative grade 2 to 3)patients,higher than 22 cases of CDFI(P=0.033).In HCC group,SMI detected 52 cases of blood-rich mode(e,f type),higher than 18 cases of CDFI(P<0.001).In non-HCC group,the difference of blood flow characteristics detection between CDFI and SMI was not statistically significant.In HCC group,SMI detected 52 cases of rich blood supply patterns,which was higher than 14 cases of non-HCC group(P<0.001).The area under the ROC curve of SMI was 0.760(sensitivity was 74.3%,specificity was 85.4%),and the SMI rich blood supply mode had the best diagnostic effect on HCC based on the blood-rich mode as the HCC diagnostic standard.In HCC group,VI was positively correlated with MVD and Ki-67(r=0.698 and r=0.669,respectively,P<0.05).Conclusions SMI has better detection ability than CDFI for HCC microvascular characteristics,HCC has more blood-rich mode than non-HCC.In HCC,VI

关 键 词：肝肿瘤 超微血管成像 彩色多普勒血流成像 微血管密度 血管指数 

分 类 号：R735.7[医药卫生—肿瘤]