提高肝表面微小转移癌超声诊断率的研究

Study of improving diagnostic ratio of superficial micro-metastasis of liver by ultrasonography

目的 探讨提高肝表面微小转移癌超声诊断率的方法及应用价值。方法 对 5 1例经手术病理确诊的肝微小转移癌 ( 5 9个病灶 ,直径≤ 1.8cm )及手术病理、CT、临床随访半年的对照组 15 8例患者(均确诊有原发性恶性肿瘤 ) ,采用高频探头、二次谐波成像技术、局部放大图像、调节聚焦、降低增益及采取患者屏气状态等 5种超声附加方法进行前瞻性研究。观察对比常规扫查法与超声附加方法前后肝表面被膜形态及回声改变。结果 肝表面微小转移癌组 5 1例中 17例 ( 33.3%)采用普通检查条件不能显示或仅提示可疑 ,而采用上述附加方法 ,超声检出率从 5 7.6 %提高达 86 .4%。假阳性 5例。该方法诊断肝转移癌的灵敏性为 84.3%,特异性为 96 .8%,诊断正确率达 93.7%。结论 对肝表面微小转移癌在超声检查中应用 5种附加方法 ,显示率及清晰度得以改善 ,提高了肝转移癌早期诊断水平。

Objective To evaluate methods for improving diagnostic ratio of superficial micro metastasis of liver by ultrasonography. Methods Fifty one cases were affirmed to have micro metastasis, while the other one hundred and fifty eight cases were controls. The additional methods involved in the study were: using high resolution (or high frequency) probes, harmonic technique, local zooming out, regulating focus, decreasing gain. Observing and comparing the before and after ultrasonographic characteristics of liver capsula and superficial were conducted .The size of metastasis was 0.3～ 1.8 cm in diameter(mean 1.1 cm).Results Seventeen cases of fifty one cases who were found metastasis were not manifested or defined by common ultrasonographic methods before using the additional methods. After using those methods, the diagnostic ratio rose from 57.6%(34/59) up to 86.4% (51/59). Ultrasonography found false metastasis in five cases of control group. In the study, the sensitivity ,specificity and accuracy of ultrasonic diagnosis of liver metastases using these methods were 84.3%(43/51), 96.8%(153/158), 93.7%(196/209),respectively. Conclusions The common detecting methods of ultrasonography have difficulties in manifesting superficial micro lesions of liver.By using these five additional methods,ultrasonographic diagnostic ratio of superficial micro metastasis is improved. So, they are helpful in detecting early stage liver metastases.