时间-强度曲线对肝脏占位性病变的诊断价值

Diagnostic value of time-intensity curve for hepatic space-occupying lesions

目的探讨超声造影(CEUS)及时间-强度曲线(TIC)对甲胎蛋白(AFP)阴性肝细胞癌(HCC)、AFP阳性HCC和肝血管瘤的诊断价值。方法选取2012年10月至2013年10月临床确诊的24例AFP阴性HCC、48例AFP阳性HCC和76例肝血管瘤患者,对3组病灶分别进行常规超声、CEUS和TIC分析,采用χ2检验比较3组的CEUS表现,采用方差分析,比较3组的TIC指标。结果 AFP阴性HCC与血管瘤的动脉期和实质期有统计学差异(χ2=39.4,P=0.001;χ2=78.9,P=0.001),AFP阳性HCC与血管瘤的动脉期和实质期差异有统计学意义(χ2=50.6,P=0.001;χ2=89.7,P=0.001),AFP阴性HCC、AFP阳性HCC动脉期和实质期差异无统计学意义(χ2=0.036,P=0.85;χ2=0.22,P=0.643);AFP阴性HCC、AFP阳性HCC和肝血管瘤峰值时间(TP)分别是(27.52±4.11)、(28.28±4.09)和(50.42±5.32)s,峰值强度(peak)分别是(49.52±4.31)%、(50.20±4.37)%和(47.83±4.29)%,ROC曲线下面积(AUC)分别是(1527.20±80.37)%s、(1725.08±78.46)%s和(1613.44±76.37)%s,平均通过时间(MTT)分别是(78.71±3.26)、(79.21±3.32)和(79.86±3.10)s,3组间TP差异有统计学意义(F=568.63,P=0.001),3组间peak值、AUC和MTT差异均无统计学意义(F=0.245、0.645、0.860,P值均>0.05)。其中AFP阴性HCC与血管瘤组间TP差异有统计学意义(P=0.001),AFP阳性HCC与血管瘤组间TP差异有统计学意义(P=0.001),AFP阴性HCC与AFP阳性HCC组间差异无统计学意义(P>0.05)。结论 CEUS表现和TP可鉴别诊断AFP阴性HCC(或AFP阳性HCC)和肝血管瘤,两者联合可提高肝脏良恶性病灶诊断价值,同时提高AFP阴性HCC的检出率。

Objective To analyze the diagnostic values of contrast-enhanced ultrasound （CEUS）and time-intensity curve （TIC）for al-pha-fetoprotein （AFP）-negative hepatocellular carcinoma （HCC）,AFP-positive HCC,and hepatic hemangioma.Methods Patients with a confirmed diagnosis from October 2012 to October 2013 were divided into AFP-negative HCC group （24 patients）,APP-positive HCC group （48 patients）,and hepatic hemangioma group （76 patients）.Routine ultrasound,CEUS,and TIC analysis were performed on the three groups.CEUS findings and TIC indices of the three groups were compared using χ^2test and independent-samples t test,respec-tively.Results There were significant differences in the CEUS findings during arterial and parenchymal phases between the AFP-negative HCC group and hemangioma group （χ^2=39.4,P=0.001;χ^2=78.9,P=0.001）,as well as between the AFP-positive HCC group and hemangioma group （χ^2=50.6,P=0.001;χ^2=89.7,P=0.001）,but no significant differences were observed in the CEUS findings dur-ing the same two phases between the AFP-negative HCC and AFP-positive HCC group （χ^2=0.036,P=0.85;χ^2=0.22,P=0.643）. The time to peak （TP）,peak intensity,area under the ROC curve （AUC）,and mean transit time （MTT）for the AFP-negative HCC group were 27.52 ±4.11 s,49.52%±4.31%,1527.20 ±80.37%s,and 78.71 ±3.26 s,respectively,versus 28.28 ±4.09 s,50.20%±4.37%, 1725.08 ±78.46%s,and 79.21 ±3.32 s,respectively,for the AFP-positive HCC group,as well as 50.42 ±5.32 s,47.83%±4.29%, 1613.44 ±76.37%s,and 79.86 ±3.10 s,respectively,for the hemangioma group;there were significant ofifferences in TP among the three groups （F=568.63,P=0.001 ）,there were no significant differences in peak intensity,AUC and MTT among the three groups （F=0.245,0.645,0.860,P〉0.05）.there were significant differences in TP between the AFP-negative HCC group and hemangioma group （P=0.001）,as well as between the AFP-positive HCC group and hemangioma group （P=0.001）,but no significant difference in TP was observed Objective To analyze the diagnostic values of contrast-enhanced ultrasound （CEUS）and time-intensity curve （TIC）for al-pha-fetoprotein （AFP）-negative hepatocellular carcinoma （HCC）,AFP-positive HCC,and hepatic hemangioma.Methods Patients with a confirmed diagnosis from October 2012 to October 2013 were divided into AFP-negative HCC group （24 patients）,APP-positive HCC group （48 patients）,and hepatic hemangioma group （76 patients）.Routine ultrasound,CEUS,and TIC analysis were performed on the three groups.CEUS findings and TIC indices of the three groups were compared using χ^2test and independent-samples t test,respec-tively.Results There were significant differences in the CEUS findings during arterial and parenchymal phases between the AFP-negative HCC group and hemangioma group （χ^2=39.4,P=0.001;χ^2=78.9,P=0.001）,as well as between the AFP-positive HCC group and hemangioma group （χ^2=50.6,P=0.001;χ^2=89.7,P=0.001）,but no significant differences were observed in the CEUS findings dur-ing the same two phases between the AFP-negative HCC and AFP-positive HCC group （χ^2=0.036,P=0.85;χ^2=0.22,P=0.643）. The time to peak （TP）,peak intensity,area under the ROC curve （AUC）,and mean transit time （MTT）for the AFP-negative HCC group were 27.52 ±4.11 s,49.52%±4.31%,1527.20 ±80.37%s,and 78.71 ±3.26 s,respectively,versus 28.28 ±4.09 s,50.20%±4.37%, 1725.08 ±78.46%s,and 79.21 ±3.32 s,respectively,for the AFP-positive HCC group,as well as 50.42 ±5.32 s,47.83%±4.29%, 1613.44 ±76.37%s,and 79.86 ±3.10 s,respectively,for the hemangioma group;there were significant ofifferences in TP among the three groups （F=568.63,P=0.001 ）,there were no significant differences in peak intensity,AUC and MTT among the three groups （F=0.245,0.645,0.860,P〉0.05）.there were significant differences in TP between the AFP-negative HCC group and hemangioma group （P=0.001）,as well as between the AFP-positive HCC group and hemangioma group （P=0.001）,but no significant difference in TP was observed＆amp;nbsp;between the AFP-negative HCC group and AFP-positive HCC group.Conclusion AFP-negative HCC （or AFP-positive HCC）and he-patic hemangioma can be diagnosed differentially by CEUS findings and TP.A combination of the two examinations can improve the diagnos-tic value for benign and malignant liver lesions and increase the detection rate of AFP-negative HCC.