定量声辐射脉冲弹性成像技术评价肝肿瘤特性的初步研究

Initial study of acoustic radiation force impulse（ARFI） elastography quantification for evaluation of solid liver tumors

目的探讨声辐射脉冲（acoustic radiation force impulse，ARFI）弹性成像技术定量评价肝肿瘤特性的价值。方法肝肿瘤患者43例56个病灶行ARFI定量检测，其中肝细胞性肝癌21例，肝转移癌8例，胆管细胞癌5例，血管瘤9例。测量肿瘤及其周围背景肝组织剪切波速度，并对30例健康志愿者肝剪切波速度进行测量对比。统计分析不同病理类型肿瘤弹性成像特征及剪切波速度差异，并与背景肝组织、正常肝组织进行比较。结果肝细胞性肝癌和胆管细胞癌硬度大于肝转移癌（P〈0．05），肝细胞癌和胆管细胞癌硬度无明显差异（P=0．179）。恶性肿瘤的硬度明显大于血管瘤和正常肝组织（P=0．000），34．5％（9／26）的肝细胞肝癌硬度小于背景肝组织，33．3％（4／12）的血管瘤硬度小于背景肝组织。以1．5m／s为剪切波速度截断值，提示肝恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为79．5％、83．3％、94．5％、52．6％。结论定量ARFI弹性成像技术有望成为一种新的定量鉴别肝血管瘤与恶性肿瘤组织参数特征的无创性检查方法。

Objective To evaluate the potential value of acoustic radiation force impulse （ARFI） elastography in the characterization of solid liver tumors. Methods Forty-three patients with 56 liver tumors were evaluated with ARFI, which included 21 patients with hepatocellular carcinoma （HCC）, 8 patients with metastase, 5 patients with cholangiocarcinoma（CCC）, and 9 patients with hemangioma. The shear wave velocity of the tumor and background liver parenchyma were calculated, and results were compared with 30 healthy subjects. Statistical analysis was performed on the shear wave velocity for differentiation of normal liver, background liver parenchyma, and tumors. Results HCC and CCC had greater stiffness than metastase （ P〈0.05）, there were no statistical differences between HCC and CCC （ P = 0. 179）. Malignant liver tumors had significantly greater stiffness than hemangioma and normal liver （P = 0. 000）. 34.5% （9/26） HCC and 33.3% （4/12） hemangioma appeared softer than the background liver. With a cut-off value of 1.5 m/s for the shear wave velocity, the sensitivity, specificity, positive predictive value and negative predictive value for malignancies were 79.50%, 83.3%, 94.5 % and 52.6%, respectively. Conclusions ARFI elastography quantification is a promising noninvasive technique for assessing solid liver tumors. Use of ARFI elastography quantification may lead to new quantitative tissue characterization parameters for differentiating hemangioma and malignant liver tumors.