超声造影延迟相廓清的肝炎性病灶与肝细胞癌的鉴别与分析

Differential diagnosis of contrast-enhanced ultrasound in delayed phase clearance of hepatitis lesions and hepatocellular carcinoma

目的探讨超声造影及其定量分析对延迟相廓清的肝炎性病灶与肝细胞癌的鉴别诊断价值。方法分析经手术或穿刺活检病理证实的38例肝炎性病灶患者(肝炎性病灶组,共38个病灶)和66例肝细胞癌患者(肝细胞癌组,66个病灶)的超声造影检查资料,分析并比较超声造影定量参数鉴别肝炎性病灶与肝细胞癌的截断值及其诊断效能。结果肝炎性病灶组与肝细胞癌组在患者性别、临床症状、血清糖水平抗原125、甲胎蛋白(AFP)水平和乙型肝炎病毒感染史等方面比较,差异均有统计学意义(均P<0.05)。肝炎性病灶组超声造影提示形态不规则和边界不清晰比例(23/38、30/38)均高于肝细胞癌组(10/66、4/66),差异均有统计学意义(均P<0.01);肝炎性病灶组表现为门脉相低增强30例、等增强8例,肝细胞癌组表现为门脉相低增强26例、等增强34例、高增强6例,两组比较差异有统计学意义(P<0.01)。定量分析显示,肝炎性病灶组时间-强度曲线的曲线下面积(AUC)较肝细胞癌组增大,下降时间、平均通行时间均较肝细胞癌组缩短,差异均有统计学意义(均P<0.05)。单变量分析结果显示,AUC>365.281、平均通行时间<22 s、下降时间<35.5 s鉴别肝炎性病灶与肝细胞癌的敏感性和特异性分别为100%和68.2%、92.4%和73.7%、100%和60.5%;Logistic回归多变量分析结果显示,AUC>365.281诊断肝炎性病灶为良性病变的符合率为100%。结论超声造影为表现为延迟相廓清的肝炎性病灶与肝细胞癌的鉴别诊断提供了重要信息,定量分析可客观地显示病灶的血流灌注特征,具有较好的临床应用价值。

Objective To investigate the value of contrast-enhanced ultrasound and quantitative analysis in the differential diagnosis of delayed phase clearance of hepatitis lesions and hepatocellular carcinoma(HCC).Methods The contrast-enhanced ultrasound data of 38 patients(hepatitis lesion group,with a total of 38 lesions)who were confirmed by surgery or biopsy and 66 HCC patients(hepatocellular carcinoma group,with a total of 66 lesions)were analyzed.The cut-off values of quantitative parameters of contrast-enhanced ultrasound in distinguishing hepatitis lesions from hepatocellular carcinoma and their diagnostic efficacy were analyzed.Results There were statistically significant differences between the hepatitis lesions group and the hepatocellular carcinoma group in gender,symptoms,serum carbohydrate antigen 125,alphafetoprotein(AFP)and hepatitis B virus infection history(all P<0.05).The proportion of irregular morphology and unclear boundary by contrast-enhanced ultrasound in the hepatitis focus group(23/38,30/38)were higher than those of the hepatocellular carcinoma group(10/66,4/66),and the differences were statistically significant(both P<0.01).There were 30 cases of low enhancement and 8 cases of isoenhancement in the hepatitis lesion group,26 cases of low enhancement,34 cases of isoenhancement and 6 cases of high enhancement in the hepatocellular carcinoma group.The difference between the two groups was statistically significant(all P<0.01).Quantitative analysis showed that the area under the curve(AUC)of the time-intensity curve of the hepatitis lesion group was larger than that of the HCC group,and the fall time(FT)and mean transit time(MTT)were shorter than those of the HCC group.The differences were statistically significant(all P<0.05).The results of univariateanalysis showed that taken AUC>365.281,MTT<22 s,FT<35.5 s as cut-off value to distinguish hepatitis lesions fromhepatocellular carcinoma,the sensitivity and specificity were 100% and 68.2%,92.4% and 73.7%,100% and 60.5%,respectively.Logistic regression multivariate analysis showed that the coincidence rate of AUC>365.281 in diagnosing hepatitislesions as benign lesions was 100%. Conclusion Contrast-enhanced ultrasound provides important information for thedifferential diagnosis of delayed phase clearance of hepatitis lesions and hepatocellular carcinoma,and quantitative analysis canobjectively show the blood perfusion characteristics of the lesion,which has good clinical application value.