超声造影在对比增强CT诊断肝硬化小肝癌中补充价值的分析

Contrast-enhanced ultrasonography as a diagnostic supplement for contrast-enhanced CT scan for small hepatocellular carcinoma with liver cirrhosis

目的 探讨肝硬化背景下超声造影对已行对比增强CT的小肝癌的补充及鉴别诊断价值.方法 2009年1月至10月收集天津医科大学附属肿瘤医院肝胆外科45例,共51个可疑肝脏占位（≤2.0 cm）的肝硬化患者对比增强CT和超声造影资料,将检查结果与病理对照,比较两项影像学检查的诊断差异.结果 超声造影与对比增强CT分别检出病灶49个和35个.小肝癌增强后典型表现为＂快进快出＂＂快进慢出＂,比较超声造影与对比增强CT诊断小肝癌敏感性及正确诊断率分别为88.9%（32/36）、69.4%（25/36）（x^2=3.02,P=0.08）和43/51（84.3%）、29/51（56.9%）（x^2=1.46,P=0.22）,差异均无统计学意义.另16个对比增强CT未能显示的病灶经超声造影明确诊断12个.结论 超声造影与对比增强CT对肝硬化伴小肝癌具有相似诊断率.超声造影较对比增强CT时间分辨力高,对对比增强CT漏检病例及不典型强化病例有很高的补充诊断价值,对于肝硬化内良性结节更具诊断及随访优势。

Objective To evaluate contrast-enhanced ultrasonography （CEUS） in diagnosis of small hepatocellular carcinoma （SHCC） （ ≤ 2. 0 cm） with liver cirrhosis after contrast-enhanced CT （CECT） examination. Methods Forty five patients with liver cirrhosis received CECT and CEUS examinations before operation or needle biopsy and the diagnosis was confirmed by pathological examination.CEUS and CECT findings of 51 liver space-occupying lesions from 45 patients were retrospectively analyzed.Results Among all 51 lesions detected CEUS and CECT found 49 and 35, respectively. The typical characteristics of SHCC were ＂fast-in and fast-out＂ and ＂fast-in and slow-out＂. The sensitivity of CEUS and CECT in diagnosis of SHCC was 88. 9% （32/36） and 69. 4 % （25/36） respectively （ x^2 = 3. 02, P =0. 08）;the diagnostic accuracy was 84. 3 % （43/51 ） and 56. 9% （29/51 ） respectively （ x^2 = 1.46, P =0. 22）. Among 16 lesions missed by CECT, 12 were detected by CEUS. Conclusions CEUS and CECT show the similar diagnostic rate for typical SHCC ,however, CEUS is more sensitive for atypical lesions. With high time resolution, CEUS have advantages for follow-up study of benign liver lesions.