常规超声与实时超声造影鉴别肝脏局灶性病变的临床价值研究

A study on clinical value of conventional ultrasound and real-time contrast-enhanced ultrasound in differential diagnosis of focal hepatic lesions

目的探求常规超声与实时超声造影在肝脏局灶性病变鉴别诊断中的价值。方法选取2015年10月至2018年3月收治的肝脏局灶性病变患者98例作为研究对象,所有患者均行常规超声、实时超声造影检查,且经病理组织学确诊,以病理组织学检查结果为“金标准”,评估常规超声与实时超声造影诊断肝脏局灶性病变良恶性价值,并比较不同类型肝脏局灶性病变的超声造影时间-强度曲线各项参数。结果98例患者经病理学诊断出110个病灶,其中67个为恶性病灶,43个为良性病灶;实时超声造影诊断肝脏局灶性病变的灵敏度(91.04%)、特异度(90.67%)及准确度(90.91%)均高于常规超声诊断结果(68.66%、72.09%、70.00%),差异有统计学意义(P<0.05);恶性病灶峰值强度较良性病灶高,峰值消退时间、增强峰值时间、开始增强时间较良性病灶短,差异有统计学意义(P<0.001)。结论相较于常规超声,实时超声造影采用时间-强度曲线获取各项参数变化特征,可有效反映肝肿瘤微小血管灌注量及血流分布情况,对临床鉴别肝脏局灶性病变的良、恶性更有诊断价值。

Objective To investigate the value of conventional ultrasound and real-time contrast-enhanced ultrasound in differential diagnosis of focal hepatic lesions. Methods 98 patients with focal hepatic lesions admitted to hospital from October 2015 to March 2018 were selected as research objects.All patients were given conventional ultrasound and real-time contrast-enhanced ultrasound examination,and then they were confirmed by pathological histology.The results of pathological histology examination were taken as the “gold standard”,and it was used to evaluate the value of conventional ultrasound and real-time contrast-enhanced ultrasound in the diagnosis of benign or malignant focal hepatic lesions.And then,the parameters of contrast-enhanced time-intensity curve of different types of focal hepatic lesions were compared. Results Among the 98 patients,110 lesions were diagnosed by pathology,of which 67 were malignant and 43 were benign.The sensitivity,specificity and accuracy of real-time contrast-enhanced ultrasound in the diagnosis of focal hepatic lesions(91.04%,90.67% and 90.91%) were higher than those of the conventional ultrasound(68.66%,72.09% and 70.00%),difference was statistically significant( P <0.05).The peak intensity of malignant lesions was higher than that of benign lesions,the peak regression time,peak enhancement time and initial enhancement time of malignant lesions were shorter than those of benign lesions,difference was statistically significant( P <0.001). Conclusion Compared with conventional ultrasound,real-time contrast-enhanced ultrasound uses time-intensity curve to obtain the characteristics of various parameters,which can effectively reflect the microvascular perfusion and blood flow distribution of liver tumors,and has more significant diagnostic value for clinical identification of benign or malignant focal hepatic lesions.