慢性HBV感染肝硬化患者肝脏恶性病变的临床及MRI和超声影像学特点

Clinical characteristics of malignant liver lesions in patients with chronic HBV infection and imaging findings of MRI and ultrasound

目的分析慢性乙型肝炎病毒(HBV)感染相关性肝硬化背景下肝脏恶性病变的临床特点及磁共振成像(MRI)、超声造影(CEUS)表现。方法回顾性分析2017年2月-2020年8月在天津市第五中心医院收治的98例HBV感染相关性肝硬化患者,所有患者均进行MRI和CEUS。以手术或肝脏穿刺病理结果为金标准,采用Kappa一致性检验分析MRI和CEUS诊断肝脏恶性病变的一致性。结果根据手术或肝脏穿刺病理结果,98例HBV感染相关性肝硬化患者分为恶性病变组(n=58)和良性病变组(n=40)。MRI显示,恶性病变组患者病灶的表观弥散系数(ADC)值低于良性病变组(P<0.05);CEUS显示,恶性病变组患者增强开始时间、增强达峰时间和增强减退时间均短于良性病变组(P<0.05)。MRI、CEUS及联合检查诊断肝脏恶性病变的敏感度、特异度、Kappa值分别为84.48%、90.00%、0.731,91.38%、87.50%、0.789和96.55%、85.00%、0.828。结论MRI和CEUS均对HBV感染相关性肝硬化患者肝脏恶性病变具有较高的诊断一致性,临床可根据其ADC值变化评估肝脏恶性病变程度。

OBJECTIVE To investigate the clinical characteristics of malignant liver lesions in patients with chronic hepatitis B virus(HBV)infection-associated liver cirrhosis and observe the imaging findings of magnetic resonance imaging(MRI)and contrast-enhanced ultrasonography(CEUS).METHODS A total of 98patients with HBV infection-associated liver cirrhosis who were treated in Tianjin Fifth Central Hospital from Feb 2017to Aug 2020 were retrospectively analyzed,all of the patients received MRI and CEUS examinations.Taken the pathological results of surgery or liver puncture as the golden standard,the consistency of MRI and CEUS in the diagnosis of malignant liver lesions was analyzed by Kappa consistency test.RESULTS According to the pathological results of surgery and liver puncture,the 98patients with HBV infection-associated liver cirrhosis were divided into the malignant lesion group with 58cases and the benign lesion group with 40cases.MRI showed that the Apparent Diffusion Coefficient(ADC)of the lesion of the malignant lesion group was significantly lower than that of the benign lesion group(P<0.05).CEUS showed that the starting time of enhancement,time of enhancement reaching to peak and time of enhancement declining were significantly shorter in the malignant lesion group than in the benign lesion group(P<0.05).The sensitivity,specificity and Kappa value of MRI,CEUS and the joint examination were respectively 84.48%,90.00%,0.731,91.38%,87.50%,0.789,96.55%,85.00%and 0.828in diagnosis of malignant liver lesions.CONCLUSION MRI and CEUS show high consistency in diagnosis of malignant liver lesions in the patients with HBV infection-associated liver cirrhosis.It is necessary for the hospital to assess the degree of malignant liver lesions based on the ADC.