超声造影时间-强度曲线相关参数鉴别诊断肝细胞癌与转移性肝癌价值研究  

Differentiation of hepatocellular carcinoma from metastatic liver cancer by time-intensity curve related parameters of contrast-enhanced ultrasonography

作　　者：梅文娟[1] 李新 张昊月 Mei Wenjuan;Li Xin;Zhang Haoyue(Department of Ultrasound,First Affiliated Hospital,Henan University of Science and Technology,Luoyang 471003,Henan Province,China)

机构地区：[1]河南科技大学第一附属医院超声科,河南省洛阳市471003

出　　处：《实用肝脏病杂志》2024年第3期430-433,共4页Journal of Practical Hepatology

基　　金：河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20191886)。

摘　　要：目的探讨超声造影(CEUS)时间-强度曲线(TIC)相关参数鉴别诊断肝细胞癌(HCC)与转移性肝癌的价值。方法2021年3月~2023年3月我院诊治的106例肝癌患者,均接受CEUS检查,记录造影剂到达时间(AT)、达峰时间(TTP)、峰值强度(PI)和上升斜率(RS)等TIC相关参数,均进行肝穿刺组织病理学检查。绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估TIC参数的鉴别诊断效能。结果在106例肝癌患者中,经病理学检查诊断为HCC者44例(41.5%)和转移性肝癌者62例(58.5%);HCC病灶AT和PI分别为(9.1±2.2)s和(41.7±5.1)dB,均显著低于转移性肝癌病灶【分别为(13.4±2.6)s和(45.8±5.5)dB,P<0.05】,而TTP为(24.8±4.7)s,显著慢于转移性肝癌病灶【(18.9±3.4)s,P<0.05】;HCC患者血清AFP水平为(226.7±37.5)ng/mL,显著高于转移性肝癌患者【(73.1±14.6)ng/mL,P<0.05】;ROC曲线分析显示,采用AT、TTP和PI联合诊断HCC的AUC为0.89(95%CI:0.83~0.96),其敏感度(Se)和特异度(Sp)分别为70.5%和95.2%,显著优于血清AFP诊断【其AUC为0.78(95%CI:0.68~0.79),其Se和Sp分别为56.8%和78.8%,P<0.05】。结论使用CEUS检测的TIC相关参数鉴别诊断HCC与转移性肝癌有一定的临床应用价值,值得进一步研究。Objective The aim of this study was to explore the differentiation of hepatocellular carcinoma(HCC)from metastatic liver cancer(MLC)by time-intensity curve(TIC)related parameters of contrast-enhanced ultrasonography(CEUS).Methods 106 patients with liver cancer were enrolled in our hospital between March 2021 and March 2023,and they all underwent CEUS examination,recording the TIC-related parameters,such as contrast agent arrival time(AT),time to peak(TTP),peak intensity(PI)and rising slope(RS).The liver biopsies was performed.The receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was applied to evaluate the differential diagnostic efficacy of TIC parameters.Results Among the 106 patients with liver cancer,the pathological examination found HCC in 44 cases(41.5%)and MLC in 62 cases(58.5%);the AT and PI in HCC lesions were(9.1±2.2)s and(41.7±5.1)dB,both significantly lower than[(13.4±2.6)s and(45.8±5.5)dB,P<0.05],while the TTP was(24.8±4.7)s,significantly slower than[(18.9±3.4)s,P<0.05]in MLC foci;serum AFP levels in patients with HCC was(226.7±37.5)ng/mL,much higher than[(73.1±14.6)ng/mL,P<0.05]in patients with MLC;the ROC analysis showed that the AUC was 0.89(95%CI:0.83-0.96),with the sensitivity(Se)and specificity(Sp)of 70.5%and 95.2%,when the combination of AT,TTP and PI was applied to diagnose the HCC,much superior to serum AFP level,the latter had the AUC of 0.78(95%CI:0.68-0.79),with the Se and Sp of 56.8%and 78.8%(P<0.05),respectively.Conclusion The TIC-related parameters of CEUS have certain clinical application in the differential diagnosis of HCC from MLC,which needs multi-center verification.

关 键 词：肝细胞癌 转移性肝癌 超声造影 时间-强度曲线 造影剂到达时间 诊断 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]