常规超声与超声造影鉴别移植肝局灶性病变的比较研究

Comparison between baseline and contrast-enhanced ultrasound in characterization of focal liver lesions after liver transplantation

目的比较常规超声和超声造影鉴别移植肝局灶性病变的诊断性能。方法对68例移植肝局灶性病变行常规超声和超声造影检查。两位不同经验的超声医生（受试者）对检查结果独立诊断，比较常规超声和超声造影鉴别移植肝局灶性病变良恶性的敏感性、特异性和准确性，Kappa值评估受试者之间的一致性。结果超声造影对不同经验的受试者均能显著提高鉴别病变良恶性的敏感性和准确性（均P〈0．05），缺乏经验的受试者提高的幅度较大。两位受试者之间的一致性超声造影较常规超声高，κ值分别为0．931和0．632。结论超声造影可显著提高对移植肝局灶病变的鉴别诊断能力。

Objective characterization of focal liver lesions after liver transplantation in comparison with baseline ultrasound. Methods Sixty-eight patients with focal liver lesions after liver transplantation were examined by baseline and contrast- enhanced ultrasound. Two independent investigators with different experience reviewed the images of baseline and contrast-enhanced ultrasound. The diagnostic performances were evaluated using sensitivity, specificity and accuracy. The interobserver agreement was analyzed. Results The sensitivity and accuracy for both investigators with different experience improved significantly after reviewing contrast-enhanced ultrasound （all P 〈 0.05）. There was greater improvement in inexperienced investigator compared with experienced investigator. A better interobserver agreement was achieved after reviewing contrast-enhanced ultrasound （κ = 0. 632 at baseline ultrasound versus κ = 0.931 at contrast-enhanced ultrasound）. Conclusions Contrast-enhanced ultrasound improves the diagnostic performance in focal liver lesions for discrimination between malignancy and benignity after liver transplantation.