超声检查在肝硬化背景下肝细胞肝癌中的诊断价值

Diagnostic value of ultrasonography in hepatocellular carcinoma with liver cirrhosis

目的探讨超声检查在肝硬化背景下肝细胞肝癌(HCC)中的诊断效能。方法选取30例肝硬化合并单发HCC患者为HCC组,选取30例肝硬化合并再生结节(RN)患者为RN组,选取30例肝硬化合并不典型增生结节(DN)患者为DN组。观察肝硬化背景下HCC、DN及RN患者的超声造影特征,比较3组患者的超声造影参数,并对各超声造影参数诊断肝硬化背景下HCC的效能进行分析。结果HCC组、DN组及RN组患者的动脉相、门脉相及延迟相超声造影特征比较,差异均有统计学意义(P<0.01);其中,HCC组患者的动脉相以高回声为主,门脉相及延迟相以低回声为主。HCC组、DN组及RN组患者的造影峰值强度、增强峰值时间及平均通过时间比较,差异均有统计学意义(P<0.01)。增强峰值时间对肝硬化背景下HCC诊断的受试者工作特征(ROC)曲线下面积最大,为0.905(95%CI:0.833~0.977),其最佳阈值23.7 s所对应的诊断灵敏度和特异度分别为95.5%和63.6%。结论超声检查对肝硬化背景下HCC具有较高的诊断价值。

Objective To investigate the diagnostic value of ultrasonography in hepatocellular carcinoma(HCC)with liver cirrhosis.Method A sum of 30 patients with liver cirrhosis combined with HCC were included as HCC group,and another 30 cases of liver cirrhosis with regenerative nodule(RN)and 30 cases of liver cirrhosis with dysplastic nodule(DN)were enrolled as RN group and DN group,respectively.The characteristics of contrast-enhanced ultrasound imaging of HCC,DN and RN patients with underlying liver cirrhosis were observed.The parameters of contrast-enhanced ultrasound in the three groups were compared,and the diagnostic efficiency of each parameter for HCC with underlying liver cirrhosis was analyzed.Result The characteristics of contrast-enhanced ultrasound imaging of arterial phase,portal venous phase and delayed phase were statistically significant differences among HCC group,DN group and RN group(P<0.01);the arterial phase in HCC group was mainly hyperechoic,while the portal venous phase and delayed phase were primarily characterized by hypoechoic lesions.The peak intensity,peak enhancement time and mean transit time differed significantly among HCC group,DN group and RN groups(P<0.01).Peak enhancement time demonstrated the largest area under the receiver operating characteristic(ROC)curve for HCC diagnosis with underlying cirrhosis as 0.905(95%CI:0.833-0.977),and the optimal threshold was 23.7 s,corresponding to the sensitivity and specificity of 95.5%and 63.6%,respectively.Conclusion Ultrasonography is of high diagnostic value for HCC with underlying cirrhosis.