超微血管成像评价肝局灶性病变的临床应用

Application of superb microvascular imaging in the evaluation of focal liver lesions

目的评估超微血管成像（superbmicrovascularimaging，SMI）显示肝局灶性病变微血管血流信号的价值。方法对54例患者共56个肝局灶性病变分别行彩色多普勒血流显像（CDFI）和SMI检查，由2名观察者对图像采用Adler半定量法进行血流分级，分析不同观察者间分级的一致性；并以超声造影为参考标准，分析两者显示血流信号能力的差异。结果两位观察者对图像进行Adler血流半定量分级，CDFI和SMI的一致性分级分别为中度（K=0．579）和高度（K=0．605）。56个病灶在三种血流成像技术显示血管的Adler半定量分级为0级、Ⅰ级、Ⅱ级、Ⅲ级的病灶个数分别为：CDFI显示4个（7．14％），25个（42．86％），14个（25％），14个（25％）；sMI显示0个（0％），12个（21．43％），12个（19．64％），33个（58．93％）；超声造影显示0个（0％），3个（5．36％），21个（37．50％），32个（57．14％）。以超声造影微血管成像动脉期所显示病灶血管分级为参考标准，CDFI血流分级的符合率为30．35％，SMI血流分级的符合率为73．21％（P〈0．01）。结论SMI具有更好的观察者间一致性，其显示肝局灶性病变微血流信号的能力优于CDFI，能显示更微小血管，在肝局灶性病变的鉴别诊断中具有潜在应用价值。

Objective To estimate the value of superb microvascular imaging（SMI） in the detection of microvascular flow signal of focal liver lesions（FLLs）. Methods A total of 54 patients with 56 FLLs who had underwent CDFI（Color Doppler Flow imaging） and SMI were included in this study. Adler semi- quantitative assessment was used to grade the distribution of blood flow signal for each FLL by two observers,then inter-observer agreement was assessed. The distribution of blood flow grade between CDFI and SMI was also compared with contrast-enhanced ultrasound（CEUS） as the reference standard. Results The inter-observer agreement for Adler semi-quantitative grading were fair （ K = 0.579） on CDFI and good （ K = 0.605） on SMI,respectively. The grade 0, Ⅰ , Ⅱ and Ⅲ of Adler semi-quantitative grading of all total 56 FLLs＇ blood flow signal on three flow imaging tools were 4（7.14%）,25（42.860/00）,14（25%）, 14（25%） on CDFI,0（0%）,12（21.43%0）,12（19.64%）,33（58.93%） on SMI,and 0（0%） ,3（5.36%）,21 （37.50%/00）,32 （57.14%） on CEUS micro-flow imaging, respectively. With CEUS blood flow distribution in the arterial phase as the reference, the coincidence rate of CDFI was 30.35~/~, while that of SMI was 73.21%. The distinction of ability on FLLrs micro-vascular imaging between CDFI and SMI was statistically significant （ P 〈0.01 ）. Conclusions The inter-observer agreement of SMI was better than that of CDFI and its capacity in displaying FLL＇s micro-vascular was superior to CDFI, SMI can exhibit more tiny vessels and thus SMI may possess potential value in the differential diagnosis of FLLs.