超声造影判断乙型肝炎肝硬化患者肝内占位性病变性质价值研究  

Diagnostic performance of contrast-enhanced ultrasound in determining qualitatively intrahepatic space-occupying lesions in patients with hepatitis B liver cirrhosis

作　　者：周莉 丁云清 袁凤英 陈竹 冯志伟 Zhou Li;Ding Yunqing;Yuan Fengying(Function Room,Public Health Clinical Medical Center,Chengdu 610066,Sichuan Province,China)

机构地区：[1]四川省成都市公共卫生临床医疗中心功能室,610066 [2]成都医学院第一附属医院超声科

出　　处：《实用肝脏病杂志》2023年第6期903-906,共4页Journal of Practical Hepatology

基　　金：四川省科技厅重点科技研发项目(编号:2020YFS0485)。

摘　　要：目的探讨应用超声造影(CEUS)肝脏影像报告与数据系统(LI-RADS)对乙型肝炎肝硬化患者肝内占位性病变性质的诊断价值。方法2020年1月~2022年1月我院诊治的乙型肝炎肝硬化伴有肝内占位性病变患者521例,均进行肝穿刺病理学活检术和CEUS检查,应用LI-RADS对病灶进行分类诊断。应用MedCalc15.1统计学软件绘制受试者工作特征并计算曲线下面积(AUROC)判断LI-RADS的诊断效能。结果在521例存在肝内占位性病变的乙型肝炎肝硬化患者中,经病理学检查诊断HCC者96例,局灶性结节性增生(FNHL)150例,血管瘤162例,肝囊肿63例,局灶性脂肪肝50例;经CEUS检查和LI-RADS评估,发现Ⅰ类病变248例(血管瘤145例,肝囊肿63例,局灶性脂肪肝40例),Ⅱ类病变140例(均为FNHL),Ⅲ类病变22例(FNHL者18例,HCC者4例),Ⅳ类病变39例(FNHL者6例,血管瘤7例,HCC 26例),Ⅴ类病变72例(FNHL者6例,HCC者66例);LI-RADS诊断V类病变的AUROC为0.84(95%CI:0.78~0.89),其灵敏度、特异度、阳性预测值和阴性预测值分别为68.8%、98.6%、91.7%和93.3%,显著优于对Ⅳ类病变【分别为0.62(95%CI:0.55~0.69)、27.1%、96.9%、66.7%和85.5%】或对Ⅲ类病变【分别为0.50(95%CI:0.44~0.56)、4.2%、95.8%、18.2%和81.6%】的诊断(P<0.05)。结论超声造影肝脏影像报告与数据系统诊断乙型肝炎肝硬化肝内I类、Ⅱ类和V类病变的性质效能较高,而对于Ⅲ类和Ⅳ类病变性质的诊断还需要综合考虑。Objective The aim of this study was to explore the diagnostic performance of contrast-enhanced ultrasound(CEUS)in determining qualitatively intrahepatic space-occupying lesions in patients with hepatitis B liver cirrhosis(LC).Methods 521 patients with hepatitis B LC were admitted to our hospital between January 2020 and January 2022,and all underwent liver biopsy and CEUS.The intrahepatic space-occupying lesions were evaluated by liver imaging reporting and data system(LI-RADS).The diagnostic efficacy of LI-RADS was evaluated by the area under receiver operating characteristic curve(AUROC).Results Out of the 521 patients with LC in our series,the liver histopathological examination showed hepatocellular carcinoma(HCC)in 96 cases,focal nodular hyperplasia of liver(FNHL)in 150 cases,hepatic hemangioma(HH)in 162 cases,hepatic cysts in 63 cases and local fatty liver in 50 cases;the diagnosis of the LI-RADS based on the CEUS evaluation found type Ⅰ lesions in 248 cases(HH in 145 cases,hepatic cysts in 63 cases and local fatty liver in 40 cases),type Ⅱ lesions in 140 cases(all was FNHL),type Ⅲ in 22 cases(FNHL in 18 cases and HCC in 4 cases),type Ⅳ lesions in 39 cases(FNHL in 6 cases,HH in 7 cases and HCC in 26 cases),and type Ⅴ lesions in 72 cases(FNHL in 6 cases and HCC in 66 cases);the AUROC was 0.84(95%CI:0.78-0.89),with the sensitivity(Se),specificity(Sp),positive predicting value(PPV)and negative predicting value(NPV)of 68.8%,98.6%,91.7%and 93.3%,respectively,when the type Ⅴ lesions was determined by LI-RADS,much superior to type IV lesions judged by LI-RADS[0.62(95%CI:0.55-0.69),27.1%,96.9%,66.7%and 85.5%]or to type Ⅲ lesions judged by LI-RADS[0.50(95%CI:0.44-0.56),4.2%,95.8%,18.2%and 81.6%,P<0.05].Conclusion The diagnostic performance on type Ⅰ,Ⅱ and Ⅴ intrahepatic lesions by liver imaging reporting and data system based on the contrast-enhanced ultrasound is excellent,but as for type Ⅲ and Ⅳ lesions,the qualitative diagnosis might be difficult and should be made comprehensively.

关 键 词：肝细胞癌 肝硬化 超声造影 肝脏影像报告与数据系统 诊断 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]