二维剪切波弹性成像在原发性肝癌应用中的研究  

Application of two-dimensional shear wave elastography in primary hepatocellular carcinoma

作　　者：陈鹏 唐少珊[2] CHEN Peng;TANG Shao-shan(Department of Cardiovascular Ultrasound,the Second Hospital of Dalian Medical University,Dalian 116027,Liaoning,China;Department of Ultrasound,Shengjing Hospital of China Medical University,Shenyang 110004,Liaoning,China)

机构地区：[1]大连医科大学附属第二医院心血管超声科,辽宁大连116027 [2]中国医科大学附属盛京医院超声科,辽宁沈阳110004

出　　处：《生物医学工程与临床》2025年第2期213-219,共7页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨二维剪切波弹性成像(2D-SWE)在原发性肝细胞癌(HCC)与肝内胆管细胞癌(ICC)鉴别诊断中的临床应用价值和HCC弹性值与其分化程度及免疫组织化学参数Ki67和P53的关系。方法选择2014年10月至2021年12月54例肝脏占位患者,其中男性41例,女性13例;年龄30~79岁,平均年龄59.32岁(标准差10.17岁);病理类型,HCC 40例,ICC 14例。采集全部病例2D-SWE图像,收集病灶的弹性值,包括与周围肝实质杨氏模量比值(Eratio)、杨氏模量平均值(Emean)、最大值(Emax)、标准差(Esd);比较HCC和ICC两组间弹性值的差异。同时收集HCC组病例的分化程度及免疫组化参数Ki67和P53的结果,分析HCC的病理诊断结果与其弹性值的关系。结果HCC的Eratio、Emean、Emax及Esd分别为3.50±2.03、(32.67±17.01)kPa、(51.28±30.16)kPa及(7.67±5.86)kPa;ICC的Eratio、Emean、Emax及Esd分别为9.79±6.05、(70.06±39.47)kPa、(118.51±61.27)kPa及(23.46±16.06)kPa。两种病灶杨氏模量参数比较,差异均有统计学意义(P<0.05)。受试者工作特性(ROC)曲线显示,2D-SWE鉴别HCC与ICC的Emean界值为48.95 kPa,灵敏度为83.3%,特异度为95.7%,ROC曲线下面积为0.953;2D-SWE鉴别HCC与ICC的Emax界值为95.70 kPa,灵敏度为83.3%,特异度为91.3%,ROC曲线下面积为0.942。中低分化HCC的Emean、Emax均明显高于高分化HCC,且差异均具有统计学意义[(36.41±18.30)kPa vs(24.92±10.86)kPa、(58.43±32.60)kPa vs(36.44±17.29)kPa。P<0.05]。Ki67表达阳性HCC的Emean明显高于Ki67表达阴性的HCC,且差异具有统计学意义[(37.04±18.68)kPa vs(23.81±10.20)kPa。P<0.05]。不同P53表达水平HCC杨氏模量参数间的差异均无统计学意义(P>0.05)。结论2D-SWE可通过测量病变的杨氏模量有效鉴别HCC与ICC,不同分化程度的HCC的杨氏模量不同,这为HCC生物学特性的预测提供了依据。Objective To explore the clinical value of two-dimensional shear wave elastography(2D-SWE)in differential diagnosis of primary hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC),and correlation between HCC Young’s module and its differentiation degree as well as immunohistochemical profiles(Ki67 and P53).Methods From October 2014 to December 2021,a total of 54 patients with focal liver lesions were enrolled,which included 41 males and 13 females,aged 30-79 years old with mean age of 59.32 years old(standard deviation 10.17 years old);40 cases of HCC and 14 cases of ICC.All of them performed 2D-SWE images to collect elastic value of lesion,including ratio of Young’s module to surrounding liver parenchyma(Eratio),mean Young’s module(Emean),the maximum value(Emax),and standard deviation(Esd).The difference of elastic values between HCC and ICC was compared.Simultaneously,the results of differentiation degree and immunohistochemical parameters(Ki67 and P53)in HCC group were collected,and correlation between pathological results and elastic values of HCC was analyzed.Results The Eratio,Emean,Emax and Esd of HCC were 3.50±2.03,(32.67±17.01)kPa,(51.28±30.16)kPa and(7.67±5.86)kPa,respectively;Eratio,Emean,Emax and Esd of ICC were 9.79±6.05,(70.06±39.47)kPa,(118.51±61.27)kPa and(23.46±16.06)kPa,respectively.There were significant differences in Young’s module parameters between 2 lesions(P<0.05).The receiver operating characteristic(ROC)curve showed that Emean cut-off value of 2D-SWE in differentiating HCC from ICC was 48.95 kPa,sensitivity was 83.3%,specificity was 95.7%,and ROC area under curve(AUC)was 0.953.The Emax cut-off value of 2D-SWE in differentiating HCC from ICC was 95.70 kPa,sensitivity was 83.3%,specificity was 91.3%,ROC AUC was 0.942.The Emean and Emax of moderately and poorly differentiated HCC were statistically significantly higher than those of well differentiated HCC[(36.41±18.30)kPa vs(24.92±10.86)kPa,(58.43±32.60)kPa vs(36.44±17.29)kPa.P<0.05].The Emean HCC with

关 键 词：超声 剪切波弹性成像 原发性肝细胞癌 肝内胆管细胞癌 

分 类 号：R735.7[医药卫生—肿瘤] R730.41[医药卫生—临床医学]