肝硬化继发小肝癌的超声造影特征及临床意义

Contrast-enhanced ultrasound characteristics of secondary small hepatocellular carcinoma and the clinical significance in patients with liver cirrhosis

目的探讨肝硬化继发小肝癌的超声造影特征及临床意义。方法选取300例肝硬化背景下肝脏占位患者为研究对象,全部患者均接受肝脏超声造影检查,以术后组织病理学检测结果为金标准,计算超声造影对肝硬化继发小肝癌的诊断效力。观察比较中-低分化癌,高分化癌和肝硬化不典型再生结节的强化方式、开始增强时间、增强峰值时间及开始消退时间的差异。结果超声造影对肝硬化继发小肝癌的诊断灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为96.3%、89.1%、97.5%、84.5%和95.0%。肝硬化不典型再生结节的开始增强时间[(25.4±7.4)s vs(16.1±4.5)s vs(17.5±5.4)s]、增强峰值时间[(53.6±12.2)s vs(24.3±7.6)s vs(26.5±8.6)s]及开始消退时间[(209.4±53.6)s vs(58.4±16.5)s vs(155.1±34.2)s]均长于中-低分化癌和高分化癌,差异有统计学意义(P﹤0.05);高分化癌的开始消退时间长于中-低分化癌[(155.1±34.2)s vs(58.4±16.5)s],差异有统计学意义(P﹤0.05)。中-低分化癌的增强方式以快进快出强化为主,比例为92.81%;高分化癌的增强方式以快进慢出强化为主,比例为89.74%;肝硬化不典型再生结节的增强方式以与肝实质同步强化为主,比例为85.45%。结论在肝硬化继发小肝癌的诊断中,超声造影诊断的准确度较高,值得临床推广及应用。

Objective： To investigate the contrast-enhanced ultrasound（CEUS） characteristics of secondary small hepatocellular carcinoma（HCC） and its clinical significance in patients with liver cirrhosis. Method 300 patients with liver cirrhosis were included in the study, all of which were examined by CEUS, with postoperative histopathologic results as the gold standard, the value of CEUS in the diagnosis of small HCC was determined. The enhancement, time to enhancement, time to peak intensity and the time to fade in moderately-poorly or highly-differentiated cancer and cirrhosis were observed. Result The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 96.3%, 89.1%, 97.5%, 84.5% and 95.0%, respectively. The time to enhancement of atypical regenerative nodules in liver cirrhosis were[（25.4 ± 7.4） s vs（16.1 ± 4.5） s vs（17.5 ± 5.4） s], time to peak intensity were[（53.6 ± 12.2） s vs（24.3±7.6） s vs（26.5±8.6） s], and time to fade were[（209.4±53.6） s vs（58.4±16.5） s vs（155.1±34.2） s], all were significantly greater than those observed in moderately-poorly and highly differentiated cancer, with statistically significant differences observed（P〈0.05）, and time to fade in highly differentiated cancer was significantly longer than that in moderately-poorly differentiated cancer[（155.1 ± 34.2） s vs（58.4 ± 16.5） s], the difference was statistically significant（P〈0.05）.The enhancement pattern in moderately-poorly differentiated cancer mainly showed as fast in and fast out, with a ratio of92.81%; while that in highly differentiated cancer was primarily as fast in and slow out, with a ratio of 89.74%; the enhancement pattern for atypical regenerative nodules in liver cirrhosis were largely synchronous with hepatic parenchyma,with a ratio of 85.45%. Conclusion The accuracy of contrast-enhanced ultrasonography in the diagnosis of small HCC with cirrhosis is high, and it is worthy of clinical application.