实时二维剪切波弹性成像在肝局灶性小病变中的预测价值研究

The predictive value of real time two-dimensional shear wave elastography in small focal liver lesions

目的探讨不同肝局灶性小病变(small focal liver lesions,SFLL)(直径≤3 cm)实时二维剪切波弹性成像(real time two-dimensional shear wave elastography,2D SWE)弹性分布特征及其在诊断SFLL良恶性病变中的应用价值。方法选取2020年7月至2023年6月首都医科大学附属北京佑安医院超声与功能诊断中心接受超声检查且SFLL直径1~3 cm的患者84例,其中病灶结节93个。对SFLL进行常规超声及2D SWE检查,根据病理诊断及增强影像学检查结果将结节分为恶性组(54个)和良性组(39个),比较两组SFLL杨氏模量的最大值(elasticity max,Emax)、平均值(elasticity mean,Emean)和离散度(elasticity discrete degree,ESD),采用ROC曲线评估2D SWE定性诊断SFLL的效能。结果84例患者中男68例,女16例,年龄30~76岁,平均(56.0±10.4)岁。93个SFLL病灶结节中恶性54个,包括原发性肝癌(primary hepatic cancer,PHC)45个和转移性肝癌(metastatic liver cancer,MLC)9个。恶性组杨氏模量值Emax、Emean、ESD高于良性组,差异均有统计学意义(P<0.05)。ROC曲线结果显示,Emax、Emean、ESD对评估SFLL良恶性的AUC分别为0.855(95%CI:0.777~0.933,P=0.000)、0.767(95%CI:0.656~0.878,P=0.000)、0.796(95%CI:0.699~0.894,P=0.000),最佳界值分别为39.84 kPa、25.14 kPa、6.46 kPa,灵敏度分别为0.8333、0.8148、0.7593,特异性分别为0.8205、0.6923、0.8205。结论2D SWE能够定量分析SFLL的弹性特征,Emax、Emean、ESD对SFLL定性诊断具有较高的诊断效能,是常规超声定性诊断SFLL的有效补充。

Objective To explore the elastic distribution characteristics of real time two-dimensional shear wave elastography(2D SWE)in different small focal liver lesions(SFLL)(diameter≤3 cm)and their application value in qualitative diagnosis of benign or malignant SFLL.Methods A total of 84 patients with SFLL diameter 1-3 cm who underwent ultrasound examination in the Department of Ultrasound and Functional Diagnosis Center,Beijing Youan Hospital,Capital Medical University from July 2020 to June 2023 were selected,including 93 lesion nodules.Routine ultrasound and 2D SWE examinations were performed on SFLL.Nodules were divided into malignant group(54 nodules)and benign group(39 nodules)according to the results of pathological diagnosis and enhanced imaging examination,The elasticity max(Emax),elasticity mean(Emean),and elasticity discrete degree(ESD)of Young’s modulus were compared between two groups.The effectiveness of 2D SWE in qualitative diagnosis of SFLL was evaluated by ROC curve.Results Among the 84 patients,there were 68 males and 16 females,aged from 30 to 76 years,with an average age of(56.0±10.4)years.Among 93 SFLL nodules,there were 54 malignant,including 45 primary hepatic cancer(PHC)and nine metastatic liver cancer(MLC).The Young's modulus values Emax,Emean,and ESD in the malignant group were higher than those in the benign group,and the differences were statistically significant(P<0.05).The ROC curve results show that Emax,Emean,and ESD had AUC values of 0.855(95%CI:0.777-0.933,P=0.000),0.767(95%CI:0.656-0.878,P=0.000)and 0.796(95%CI:0.699-0.894,P=0.000)for evaluating the malignancy of SFLL.The optimal cutoff values were 39.84 kPa,25.14 kPa and 6.46 kPa.the sensitivity were 0.8333,0.8148 and 0.7593,and the specificity were 0.8205,0.6923,0.8205 respectively.Conclusions 2D SWE can quantitatively analyze the elastic characteristics of SFLL,and Emax,Emean,and ESD have high diagnostic efficacy in qualitative diagnosis of SFLL,which is an effective supplement to conventional ultrasonic qualitative diagnosis of SFLL.