超声造影定量分析在肝细胞癌门静脉癌栓诊断和分型中的价值

Role of contrast-enhanced ultrasound quantitative analysis in the diagnosis and classification of portal vein tumor thrombus

目的观察肝细胞癌患者门静脉癌栓(portal vein tumor thrombosis,PVTT)的超声造影(contrast-enhanced ultrasound,CEUS)模式和定量参数变化,探讨CEUS在PVTT诊断和分型中的应用价值。方法肝细胞癌合并PVTT患者76例,术前均行CEUS和增强CT(contrast-enhanced CT,CECT)扫描。分析肝细胞癌合并PVTT患者的CEUS灌注模式;以术后组织病理结果为金标准,比较CEUS和CECT对PVTT诊断和分型的效能;比较PVTT与周围肝组织CEUS定量参数以及PVTT不同分型的CEUS定量参数差异。结果PVTT呈“快进快出”CEUS灌注模式,其中74例动脉相呈高增强,65例门脉相呈低增强,76例延迟相均呈低增强。CEUS对PVTT诊断及分型的准确率(98.7%、96.1%)与CECT(97.4%、93.4%)比较差异均无统计学意义(P>0.05)。PVTT CEUS定量参数中到达时间[(12.13±4.31)s]、达峰时间[(30.23±5.19)s]、上升时间[(22.29±4.15)s]和流出时间[(98.77±5.12)s]均短于周围肝组织[(15.89±4.68)s、(37.43±6.68)s、(25.99±5.15)s、(108.51±4.27)s](P<0.05),峰值强度[(37.12±5.35)dB]、上升支斜率(1.21±0.22)和曲线下面积[(2291±209)dB/s]均大于周围肝组织[(29.82±7.17)dB、0.87±0.18、(1701±187)dB/s](P<0.05),PVTT不同分型患者CEUS定量参数中到达时间、达峰时间、上升时间、峰值强度、上升支斜率、流出时间和曲线下面积比较差异均无统计学意义(P>0.05)。结论CEUS和CECT对PVTT诊断和分型的准确率均较高,CEUS定量分析参数可用于PVTT治疗前的准确评估。

Objective To investigate the clinical values of contrast-enhanced ultrasound(CEUS)penfusion mode and quantitative analysis to the diagnosis and classification of portal vein tumor thrombus(PVTT)in patients with hepatocellular carcinoma(HCC).Methods Seventy-six patients with HCC and PVTT were performed CEUS and contrast-enhanced CT(CECT),and the CEUS perfusion mode of PVTT was analyzed.The postoperative pathological result was regarded as gold standard to compare the diagnosis and classification efficacies of CEUS and CECT on PVTT.The differences of CEUS quantitative parameters were compared between PVTT and its surrounding liver tissues,and among different PVTT classifications.Results The CEUS of PVTT was characterized by“fast-in and fast-out”,high enhancement in arterial phase in 74patients,low enhancement in portal phase in 65patients and low enhancement in delayed phase in all patients.The accuracies of CEUS(98.7%,96.1%)and CECT(97.4%,93.4%)on the diagnosis and classification of PVTT showed no significant differences.The arrival time((12.13±4.31)s),time to peak((30.23±5.19)s),rise time((22.29±4.15)s)and washout time((98.77±5.12)s)of PVTT on CEUS were earlier than those of peripheral liver tissue((15.89±4.68)s,(37.43±6.68)s,(25.99±5.15)s,(108.51±4.27)s)(P<0.05),and the peak intensity((37.12±5.35)dB),rising-slope rate(1.21±0.22)and area under the curve((2291±209)dB/s)of PVTT were greater than those of peripheral liver tissue((29.82±7.17)dB,0.87±0.18,(1701±187)dB/s)(P<0.05),while all the above parameters showed no significant differences among different classifications of PVTT(P>0.05).Conclusion Both CEUS and CECT have high accuracies in the diagnosis and classification of PVTT.CEUS quantitative analysis can be used in accurate evaluation of PVTT before treatment.