联合应用两种超声弹性成像技术诊断肝脏局灶性病变良恶性的价值研究

Value of Combined Application of Two Ultrasonic Elastography Techniques in Diagnosis of Benign and Malignant Focal Liver Lesions

目的探讨联合应用两种超声弹性成像技术诊断肝脏局灶性病变(FLLs)良恶性的价值。方法选取2018年10月至2019年5月在哈尔滨医科大学附属第一医院腹部超声科检查的FLLs患者51例,共59处常规超声难以定性的FLLs,使用具备实时组织弹性成像(RTE)和剪切波速度测量(SWM)功能的超声诊断仪进行检查,以病理诊断作为金标准,评估比较联合弹性成像的诊断效能。结果59个FLLs病灶病理检查结果显示:恶性病灶39个(肝细胞癌26个,胆管细胞癌5个,肝转移癌8个),良性病灶20个(血管瘤11个,肝硬化结节3个,腺瘤3个,炎性结节3个)。参照病理组织检查结果,共确诊恶性病灶31个,良性病灶10个,准确度为69.49%(41/59)。在59个FLLs病灶中,良性组杨氏模量值低于恶性组[6.31(4.59,11.45)k Pa比11.14(6.77,15.44)k Pa](P<0.05)。受试者工作特征曲线显示,SWM的曲线下面积为0.722,诊断FLLs良恶性的截断值为7.075 k Pa,其中23个病灶截断值<7.075 k Pa,诊断为良性,36个病灶截断值≥7.075 k Pa,诊断为恶性。联合弹性成像诊断的准确度为83.05%(49/59)。联合弹性成像的灵敏度、特异度、阳性预测值、阴性预测值、准确度均高于两种方法单独检测,其中联合检测的阳性率与RTE的阳性率比较差异无统计学意义(P>0.05),两种方法诊断结果的一致性一般(Kappa=0.422,P<0.01);联合检测的阳性率与SWM的阳性率比较差异无统计学意义(P>0.05),两种方法诊断结果的一致性一般(Kappa=0.435,P<0.01)。结论联合弹性成像结果可为临床医师判断肝内病灶的性质提供硬度信息,与其他影像学方法联合可进一步提高诊断准确率,有助于鉴别良恶性病灶。

Objective To explore the value of combined application of two ultrasonic elastography techniques in the diagnosis of benign and malignant focal liver lesions(FLLS).Methods A total of 51 patients with FLLs diagnosed and treated in the First Affiliated Hospital of Harbin Medical University from Oct.2018 to May 2019 were included.There were altogether 59 FLLs difficult to be identified by conventional ultrasound,which were examined by ultrasonic diagnostic equipment with both real-time elastography(RTE)and shear wave measurement(SWM)functions.The results of the combined elastography were compared with pathologic diagnosis as the gold standard to evaluate the diagnostic efficacy.Results The pathologic examination of the 59 FLLs showed:39 malignant lesions(26 hepatocellular carcinoma,5 cholangiocarcinoma,8 liver metastases),20 benign lesions(11 angiocavernoma,3 cirrhotic nodules,3 adenomas and3 inflammatory nodules).According to the results of histopathological examination,31 malignant lesions and 10 benign lesions were diagnosed,with an accuracy rate of 69.49%(41/59).Among the 59 FLLS lesions,the modulus value of the benign group was lower than that of the malignant group[6.31(4.59,11.45)k Pa vs 11.14(6.77,15.44)k Pa](P<0.05).The receiver operating characteristic showed that the area under the curve of SWM was 0.722,and the cut-off value for diagnosing benign and malignant FLLs was7.075 k Pa,of which 23 lesions had the values less than 7.075 k Pa,which were diagnosed as benign,and 36 lesions has the values greater than 7.075 k Pa,which were diagnosed as malignant.The correct rate of combined elastography diagnosis was 83.05%(49/59).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of combined elastography were higher than those of either of the two methods alone.There was no significant difference between the positive rate of the combined detection and that of RTE(P>0.05),and the consistency of the diagnosis results of the two methods was general(Kappa=0.422,P<0.01);there was no significant difference in the positive rate betweened the combined detection and SWM(P>0.05),the consistency of the diagnosis results of the two methods was general(Kappa=0.435,P<0.01).Conclusion The combined elastography results can provide clinicians with hardness information for diagnosing the nature of intrahepatic lesions.Combined with other imaging methods,the elastography can further improve the diagnostic accuracy and is helpful for differentiation of the benign and malignant lesions.