超声造影在老年肝恶性肿瘤诊断及介入治疗评价中的应用价值探讨

Application value of ultrasonography in diagnosis and interventional evaluation in elderly patients with liver malignant tumor

目的探讨超声造影用于老年肝恶性肿瘤诊断及介入治疗的价值。方法选取我院2013年2月至2016年5月120例疑似肝恶性肿瘤老年患者,对于肝脏占位性病变进行超声造影检查,记录各个病灶造影增强模式,分析造影前后的占位性病变评分情况,对超声造影在介入治疗中差别进行分析。结果穿刺活检后病理确诊13例为肝血管瘤、9例为肝囊肿,98例为肝恶性肿瘤患者。其中肝恶性肿瘤患者超声检查发现95例,漏诊3例,均由于酒精性肝硬化,超声病灶后方回声团衰减而漏诊。超声造影对于肝恶性肿瘤的灵敏度为96.94%(95/98)。中-低分化组开始增强时间明显短于透明肝癌组,开始消退时间明显短于高分化组(P<0.05),98个肝恶性肿瘤病灶造影前图像典型较少,仅70.41%(69/98)有疑似或明确恶性诊断,超声造影后评分提高≥2分的病灶为35例,占35.71%,造影后评价为5分的病灶为81例,超声造影对肝恶性肿瘤诊断准确性为82.65%(81/98)。结论超声造影用于老年患者肝恶性肿瘤诊断及介入治疗有重要意义,造影可提高超声的诊断率,可作为辅助诊断肝恶性肿瘤的影像学方法,其灵敏度与准确度均较高,安全简便,可作为肝恶性肿瘤介入疗效评价的重要指标。

To investigate the value of contrast-enhanced ultrasonography(CEUS)in diagnosis and interventional treatment in elderly patients with liver malignant tumor.We selected 120 patients with liver malignant tumor in our hospital from February 2013 to May 2015.We used ultrasonography to examine the liver space occupying lesions,recorded each lesion contrast enhancement pattern,and analyzed the lesion grading before and after the angiography.Finally,the differences in the ultrasonic angiography after interventional treatment were analyzed.In pathological examination of biopsy,13 were diagnosed as hepatic hemangioma,9 as hepatic cyst and 98 as liver cancer.In CEUS,95 were diagnosed as liver cancer with 3 missed diagnoses.The missed diagnostic cases showed ultrasound posterior echo mass attenuation of lesions due to alcoholic liver cirrhosis.Therefore,the sensitivity of CEUS for diagnosis of liver malignancy was 96.94%(95/98).Moreover,time of the echo enhancement in patients with medium-low differentiation of cancer was significantly shorter than that in patients with clear cell cancer and time of echo subside was significantly shorter than that in patients with high differentiation(P<0.05).Typical ultrasonic images in 98 liver cancers were less before CEUS with only 70.41%(68/98)showing suspected images.There were 35 cases(35.71%)increasing scores more than 2 points after CUUS and there were 81cases with score equal to 5 points.Therefore,the accuracy of CEUS for diagnosis of liver malignancy was 82.65%(81/98).The CEUS for diagnosis and interventional treatment of elderly patients with hepatic malignant tumor has a great clinical significance.CEUS can improve the diagnosis rate of ultrasound.It can be used as an auxiliary diagnosis for imaging diagnosis of hepatic malignant tumor.Its sensitivity and accuracy are high.The method is simple and safe.It also can be used as an important index for evaluating the therapeutic efficacy of liver malignant tumor.