比较CEUS与增强CT对肝硬化背景下<3cm结节样肝内小结节病灶的诊断效果

Contrast-enhanced ultrasound vs contrast-enhanced computed tomography for diagnosis of small nodules(<3 cm) in the liver of patients with liver cirrhosis

目的:使用超声造影(contrast-enhanced ultrasound,CEUS)和增强螺旋CT(contrastenhanced helical computed tomography,C E C T)观察肝硬化背景下结节样小病灶(<3 cm)造影增强模式的差异,比较CEUS和CECT 2种检查方法对肝内小结节病变的诊断效果.方法:对88名肝硬化患者合并105个肝脏小结节病灶(<3 cm)进行Sono Vue CEUS和C E C T检查,并以穿刺活检结果或病理结果为对照,评估2种检查方法的诊断效能.结果:105个肝内小结节病灶中,经病理证实有54个小肝癌(small hepatocellular carcinoma,SHCC),其中高分化25个,中低分化29个;51个良性结节,其中肝硬化再生结节36个,增生不良结节10个(2个为高度增生不良结节),局灶性炎症灶3个,血管瘤1个,局灶性结节增生1个.CEUS诊断出SHCC 50个,良性结节49个;CECT诊断出SHCC 46个,良性结节49个.有6个结节被CEUS与C E C T同时误诊,包括4个S H C C,1个高度增生不良结节和1个局灶性炎症灶.CEUS和CECT的敏感性(P=0.221)、特异性(P=1.000)和准确性(P=0.435)差异均无统计学意义.结论:CEUS和CECT对肝硬化相关局灶性小结节性质的诊断效能差异无统计学意义,二者均可作为肝硬化患者合并小结节病变的有效筛选手段,能明显提高检出率.C E U S实时动态的特点,可以完整、动态地观察整个增强时相表现,为客观评价病变性质提供了更准确的依据,但对位置较深的病灶显影效果欠佳,需注意结合其他检查方法进行诊断.

AIM： To compare the diagnostic yield of contrast-enhanced ultrasound （CEUS） vs contrast-enhanced computed tomography （CECT） in the detection of small lesions in the liver of patients with liver cirrhosis.METHODS： One hundred and five small hepatic nodular lesions in 88 patients withcirrhosis were examined by CEUS and CECT. Based on the biopsy or pathological results, the diagnostic performance of the two modalities was compared. RESULTS： Of the 105 small lesions, 54 were small hepatocellular carcinoma （SHCC） （high differentiation 25, low differentiation 29）, 51 were benign nodules （regeneration nodules 36, highly dysplastic nodules 10）, 3 were focal inflammatory lesions, 1 was hemangioma, and 1 was focal nodular hyperplasia. The ability to judge the nature of small lesions between CEUS and CECT was not different. CONCLUSION： There is no obvious difference in diagnostic efficiency between CEUS and CECT. Both CEUS and CECT can be used as effective methods for screening of small nodules.