超声造影定量诊断肝纤维化

Quantitative diagnostic value of contrast enhanced ultrasound of liver fibrosis

目的探讨CEUS定量诊断肝纤维化的可行性及意义。方法对肝纤维化组118例及对照组27例患者行CEUS检查,应用时间-强度曲线记录造影剂到达肝动脉、肝静脉、门静脉及肝实质的时间及达峰值时间,分析不同分期肝纤维化的灌注规律。结果在不同分期肝纤维化患者中,造影剂到达肝动脉时间、达峰值时间及门静脉达峰值时间的差异无统计学意义(P均>0.05);S1～S4期患者门静脉到达时间均长于S0(P均<0.05);S3及S4期患者肝静脉到达时间显著短于S0期(P均<0.05);S4期患者肝实质达峰值时间显著早于S0期(P<0.05)。应用ROC曲线,以肝静脉到达时间≤23s为界值,CEUS诊断肝硬化(S4)的敏感度为79.0%,特异度为85.2%;以肝实质达峰值时间≤27s为界值,诊断肝硬化的敏感度为55.6%,特异度为100%。结论 CEUS技术有助于定量诊断肝纤维化,并有望对肝硬化前期做出诊断。

Objective To explore the quantitative diagnostic value of CEUS of liver fibrosis. Methods Totally 145 pa- tients underwent CEUS, including 118 patients with hepatitis history （ liver fibrosis group） and 27 patients without chronic hepatitis history and clinical signs （control group）. Liver samples were achieved with biopsy or operation. The arrival time and peak time of hepatic artery, hepatic vein, portal vein and liver parenchyma were observed by using time intensity curves, and the relationship of fibrosis stages and the perfusion times among each stage was investigated. Results The ar- rival time and peak time of hepatic artery and the peak time of portal vein were not significantly different in different fibrosis stage. The arrival time of portal vein in S1--S4 was longer than SO （all P〈0.05）. The arrival time of hepatic vein in S3 and S4 were significantly shorter than SO （both P〈0.05）. The peak enhancement time of liver parenchyma in S4 was earli- er than SO （P〈0.05）. ROC analysis showed when the arrival time of hepatic yein 423 s, the sensitivity and specificity of CEUS in diagnosis of liver cirrhosis （S4） was 79.0% and 85.2%, for the peak time of liver parenchyma ≤27 s, the value of sensitivity and specificity was 55.6% and 100%, respectively. Conclusion CEUS has potential as non-invasive diagnos- tic modality for cirrhosis, and may be useful to diagnosis of pre-cirrhosis.