超声造影定量分析鉴别肝脏局灶性结节性增生与原发性肝癌初步探讨

Value of contrast-enhanced ultrasonography in differential diagnosis of patients with focal nodular hyperplasia and hepatocellular carcinoma

目的探讨超声造影定量分析鉴别诊断肝脏局灶性结节性增生(FNH)与肝细胞癌(HCC)的价值。方法2015年2月～2017年2月本院接受超声造影检查的FNH和HCC患者各90例,均行超声造影检查,应用SonoLiver CAP软件定量分析病灶内感兴趣区(ROI)时间-强度变化,获得定量分析参数峰值强度(IMAX)、达峰时间(TTP)、上升时间(RT)、渡越平均时间(m TT),计算血流灌注指数(PI),并比较两组动态血管模型(DVP)曲线分型差异。结果 FNH组IMAX和m TT分别为(142.6±17.8)%和(268.9±34.5) s,显著大于HCC组[分别为(125.3±14.7)%和(117.8±15.4) s,P<0.05];RT、PI和TTP分别为(17.2±2.9) s、(91.2±12.8)和(30.4±5.2)s,显著小于HCC组[分别为(21.5±4.3) s、(45.6±7.3)和(34.1±5.9) s,P<0.05];HCC组DVP曲线分型I型(消退型)、II型(未消退型)和III型(负向型)占比分别为75.6%、22.2%和2.2%,而FNH组则分别为43.3%、54.4%和2.2%,差异有统计学意义(x^2=20.048,P<0.05);HCC组DVP参数分布图I型、II型和III型占比分别为72.2%、25.6%和2.2%,而FNH组则分别为40.0%、56.7%和3.3%,两组差异有统计学意义(x^2=19.121,P<0.05)。结论超声造影定量参数和直观DVP参数成像有助于临床对FNH与HCC的鉴别诊断,值得进一步探讨。

Objective To explore the efficacy of contrast-enhanced ultrasonography (CEU) in differential diagnosis of patients with focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC). Methods Ninety patients with FNH and 90 with HCC were enrolled in this study between February 2015 and February 2017, and all patients underwent CEU examination. The region of interest(ROI) was analyzed by SonoLiver CAP software,and the maximum of intensity (IMAX),the time to peak (TTP),the rise time (RT),the mean transit time (mTT) and the perfusion index(PI) were obtained. The types and parameter distributions in dynamic vascular model(DVP) curve were compared between the two groups. Results The IMAX and mTT in FNH group were (142.6±17.8)% and (268.9±34.5) s,significantly greater than [(125.3±14.7)% and (117.8±15.4) s,P<0.05] in HCC group;the RT,PI and TTP were(17.2±2.9) s,(91.2±12.8) and (30.4±5.2) s,much lower than [(21.5±4.3) s,(45.6±7.3) and (34.1±5.9) s,P<0.05] in HCC group;the type Ⅰ(regression type),type Ⅱ(end regression type) and type Ⅲ(negative type) DVP curve in HCC group accounted for 75.6%,22.2% and 2.2%,significantly different as compared to 43.3%,54.4% and 2.2% in the FNH group (P<0.05);the percentages of type Ⅰ,type Ⅱ and type Ⅲ DVP parameter distribution in HCC group were 72.2%,25.6% and 2.2%,while they were 40.0%,56.7% and 3.3% in FNH group,respectively,statistically significantly different between the two groups (x^2=19.121,P<0.05). Conclusion Quantitative parameters of CEU and visual imaging of DVP parameters are helpful in differentiating patients with FNH and with HCC in clinical practice.