超声造影新技术鉴别诊断肝脏局灶性病变的研究

Characterization of focal liver lesions using an innovative contrast-enhanced ultrasound technique

目的评价超声造影新技术鉴别诊断肝脏局灶性病变(FLL)的临床应用价值。方法采用六氟化硫微气泡造影剂和连续实时成像的对比脉冲序列技术,对505例FLL作超声造影检查。分析病灶增强开始时间、增强的水平、形态和随时相变化的特点。结果良、恶性FLL的增强开始时间和增强水平等表现均可相似,定性诊断最有意义的指标是增强随时相的变化。绝大多数恶性病变表现动脉期不同程度增强,至延迟期消退为低增强,良性病变则为动脉期增强后延迟期仍保持高增强或等增强,或整个造影过程均无增强。以此作为鉴别诊断的标准,诊断性试验显示超声造影诊断恶性FLL的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为95.7%(313/327)、86.0%(153/178)、92.6%(313/338)、91.6%(153/167)和92.3%(466/505)。结论超声造影新技术鉴别诊断FLL,安全简便、准确性高,值得推广应用。

Objective To evaluate the clinical performance of an innovative contrast-enhanced ultrasound （CEUS） technique in characterization of focal liver lesions （FLL）. Methods CEUS was performed in 505 patients with FLLs. A sulfur hexafluoride-filled microbubble ultrasound contrast agent and a continuous real-time imaging technique of contrast pulse sequencing were used. The observation items included initial nodule enhancement time, enhancement level and pattern, and dynamic evolution of enhancement along with the CEUS phases. Results There were similar findings for both malignant and benign FLLs in initial enhancement time and enhancement level on CEUS. The dynamic evolution of enhancement along with enhancement phase was the most significant parameter for characterization of FLLs. Most malignant lesions showed enhancement at arterial phase and hypo-enhancing at late phase, whereas the benign lesions presented enhancement at arterial phase and persistent hyper- or iso-enhancing until late phase. Using these characteristics as a diagnostic criteria, the sensitivity, specificity, positive predicative value, negative predicative value and accuracy of CEUS in identifying malignant FLLs were 95.7% （313/ 327）, 86. 0% （ 153/178）, 92. 6% （313/338）, 91.6% （153/167） and 92. 3% （466/505）, respectively. Condusions Characterization of FLLs by using the innovative CEUS technique is recommendable due to its safety, facility and high accuracy.