超声造影对肝细胞癌高危患者肝占位性病变的鉴别诊断价值  

Value of contrast-enhanced ultrasonography in differential diagnosis of hepatic space-occupying lesions in high-risk patients with hepatocellular carcinoma

作　　者：潘龙 刘晓刚[2] 张惠民 王长友 PAN Long;LIU Xiao-gang;ZHANG Hui-min;WANG Chang-you(Department of Ultrasound Diagnosis,Kailuan General Hospital Linxi Hospital,Tangshan 063000,Hebei;Department of Hepatobiliary,Tangshan Workers′Hospital,Tangshan,063000,Hebei;Department of General Surgery,North China University of Technology Affiliated Hospital,Tangshan 063000,China)

机构地区：[1]开滦总医院林西医院超声诊断科,河北063000 [2]唐山市工人医院肝胆外科,063000 [3]华北理工大学附属医院普外科,063000

出　　处：《肝脏》2024年第5期530-533,共4页Chinese Hepatology

基　　金：河北省中医药管理局2021年度立项课题(2021413)。

摘　　要：目的探讨超声造影对肝细胞癌高危患者肝占位性病变的鉴别诊断价值。方法回顾性分析2018年9月—2022年6月来院就诊的160例肝细胞癌高危患者肝占位性病变(204个病灶)的影像学资料,所有患者均行超声造影检查,以病理检查为金标准,分析超声造影检查与病理检查的一致性,比较良性肝脏占位性病变与恶性肝脏占位性病变造影检查时开始增强时间、达峰时间和开始消退时间。结果160例肝细胞癌高危患者共有204个肝占位性病变病灶,经手术或穿刺病理检查,共有158个恶性病变,包括93个肝细胞肝癌病灶、56个转移性肝癌病灶和9个胆管细胞型肝癌病灶;46个良性病变,包括34个肝血管瘤、7个肝硬化结节病灶和5个肝脏局灶性结节增生病灶;恶性肝脏占位性病变超声造影检查开始增强时间、达峰时间和开始消退时间均短于良性肝脏占位性病变(P<0.05);204个肝占位性病变病灶中,超声造影检查诊断检出151个恶性病灶与病理诊断一致,37个良性病灶与病理诊断一致,经Kappa一致性检验,Kappa=0.772,P<0.05,2种诊断方法的一致性较好;ROC分析显示,超声造影检查诊断肝细胞癌高危患者肝占位性病变恶性病灶的灵敏度、特异度和约登指数分别为95.57%(151/158),80.43%(37/46),0.760。结论超声造影用于肝细胞癌高危患者肝占位性病变鉴别诊断具有重要价值。Objective To assess the efficacy of contrast-enhanced ultrasonography in differentiating hepatic space-occupying lesions in high-risk patients with hepatocellular carcinoma.Methods A retrospective analysis was conducted on the imaging data from 160 high-risk patients diagnosed with hepatocellular carcinoma who had presented with space-occupying lesions(204 lesions)between September 2018 and June 2022.All patients underwent contrast-enhanced ultrasonography,with pathological examination being utilized as the gold standard.The consistency between contrast-enhanced ultrasonography finding and pathological results was assessed.Additionally,the arrival time,the peak time,the washout time were compared between benign and malignant liver lesions.Results A total of 204 liver space-occupying lesions were identified in the study cohort,,of which 158 malignant lesions(93 hepatocellular carcinoma lesions,56 metastatic hepatocellular carcinoma,and 9 cholangiocarcinoma)and 46 benign lesions(34 hepatic hemangioma,7 cirrhotic nodular lesions and 5 hepatic focal nodular hyperplasia lesions).Malignant lesions demonstrated earlier arrival time,shorter peak time,and earlier washout time compared to benign lesions(P<0.05).Among the 204 hepatic focal lesions,contrast-enhanced ultrasound diagnosed 151 malignant lesions and 37 benign lesions,aligning well with the pathological diagnoses and demonstrating good agreement(Kappa=0.772,P<0.05).ROC analysis indicated that the sensitivity,specificity and Youden index of contrast-enhanced ultrasonography in diagnosing malignant liver space-occupying lesions in high-risk patients with hepatocellular carcinoma were 95.57%(151/158),80.43%(37/46),and 0.760,respectively.Conclusion CEUS emerges as a valuable modality for distinguishing between hepatic space-occupying lesions in high-risk patients with hepatocellular carcinoma.

关 键 词：超声造影 肝细胞癌 高危人群 肝占位性病变 

分 类 号：R735.7[医药卫生—肿瘤]