超声造影鉴别肝脏局灶性病变良恶性的临床意义

Clinical significance of contrast-enhanced ultrasound for differentiating benign from malignant focal liver lesions

目的评价超声造影技术在鉴别良恶性肝脏局灶性病变中的临床意义,并与常规超声比较。方法 83例经穿刺活检及手术或临床证实的肝脏局灶性病变(38例恶性和45例良性)均经常规超声和超声造影检查,对肝脏局灶性病变在造影检查中的强化型式与时相特征逐例进行了观察与记录,并用卡方检验比较了两种方法对肝脏局灶性病变的诊断效能。结果肝脏局灶性病变随其良性与恶性而表现为不同的强化型式与时相特征。超声造影正确诊断34例恶性和43例良性病变,其诊断敏感性、特异性和准确性分别为89.5%、95.6%和92.8%,而常规超声正确诊断23例恶性和22例良性病变,其诊断敏感性、特异性和准确性分别为60.5%、48.9%和54.2%。两种方法诊断效能比较有统计学差异(P<0.01)。结论超声造影技术在肝脏局灶性病变良恶性鉴别诊断中具有重要的临床应用价值,并可取代常规超声。

Objective To evaluate the clinical significance of contrast-enhanced ultrasound（CEUS） for differentiating benign from malignant focal liver lesions（FLLs） and to compare with that of routine ultrasound（RUS）.Methods Eighty-three patients with clinically punctured biopsy and postoperalive pathology proved FLLs which comprised 38 malignancy and 45 benignancy underwent the abdominal examinations of CEUS and RUS.The enhanced patterns and phasic features of FLLs during dynamic CEUS were observed and recorded for each case.The comparison of the diagnostic capability between CEUS and RUS for FLLs was performed with Chi-square test.Results FLLs with their pathologic types appeared as different enhanced patterns and phasic features.Among 83 patients,CEUS correctly diagnosed 34 malignancy and 43 benignancy,the diagnostic sensitivity,specificity and accuracy were 89.5%,95.6% and 92.8%,respectively,while RUS correctly diagnosed 23 malignancy and 22 benignancy,the diagnostic sensitivity,specificity and accuracy were 60.5%,48.9% and 54.2%,respectively.The comparison of the diagnostic capability between CEUS and RUS was statistic difference（P 0.01）.Conclusion CEUS in differentiating benign from malignant FLLs has important value and may replace RUS.