肝细胞腺瘤超声造影与增强CT表现对比分析

Contrastive study of contrast-enhanced ultrasound or contrast-enhanced CT in diagnosis of hepatocellular adenoma

目的明确超声造影(contrast-enhanced ultrasound,CEUS)和增强CT(contrast-enhanced CT,CECT)对肝细胞腺瘤(hepatocellular adenoma,HCA)的诊断价值。方法回顾性分析病理确诊为HCA且术前行CEUS和CECT检查的21例患者共21个病灶资料,观察HCA的CEUS及CECT特征性影像学表现。结果本研究HCA病灶在CEUS和CECT动脉期均呈高增强100%(21/21);门脉期分别观察到14.3%(3/21)和19.1%(4/21)呈低增强;延迟期分别见33.3%(7/21)和42.9%(9/21)呈低增强,两者在显示“增强-减退”方面差异无统计学意义。CEUS对包膜下增强血管影的显示率高于CECT(McNemar,P=0.028)。对比大体病理标本,CEUS、CECT对病灶内出血区的显示率差异均有统计学意义(CEUS vs大体病理,P=0.045;CECT vs大体病理,P=0.023),而且一致性均较低(CEUS vs大体病理,Kappa值=0.327;CECT vs大体病理,Kappa值=0.440)。以“快进慢出”和“包膜下增强血管影”为依据诊断HCA,CEUS显示率为47.6%,CECT显示率为33.3%,两者结合诊断率约52.4%。CEUS结合CECT诊断率与CEUS单独应用差异无统计学意义。根据免疫组化染色结果,共12个炎症型HCA(inflammatory-HCA)病灶被纳入研究。I-HCA在CEUS动脉期75.0%(8/12)呈整体增强;延迟期41.7%(5/12)呈低增强,41.7%(5/12)见包膜下增强血管影,16.7%(2/12)见灌注缺损区。I-HCA在CECT动脉期33.3%(4/12)呈不均匀增强;延迟期50.0%(6/12)呈低增强,16.7%(2/12)见包膜下增强血管影,25.0%(3/12)见灌注缺损区。“灰阶超声低回声、CEUS动脉期高增强、包膜下增强血管影”在I-HCA中的显示率约41.7%,出现该征象可提示I-HCA。结论CEUS对HCA诊断符合率高于CECT,且CEUS对动脉期增强方式和包膜下增强血管影的显示较CECT更具有优势,CECT结合CEUS可提高HCA的术前诊断准确性。

Objective To explore the diagnostic value of contrast-enhanced ultrasound(CEUS)and contrast-enhanced CT(CECT)for HCA.Methods Clinical data of 21 hepatocellular adenoma(HCA)lesions in 21 patients confirmed by pathology were collected.The CEUS and CECT imaging findings of HCA lesions were analyzed respectively.Results 100%(21/21)of HCA showed hyper-enhancement in arterial phase on CEUS and CECT.In portal venous phase,14.3%(3/21)and 19.1%(4/21)of lesions showed hypo-enhancement,respectively.During late phase,33.3%(7/21)and 42.9%(9/21)of HCA showed washout,respectively.There was no statistical difference in enhancement performance of HCA between CEUS and CECT.The detection rate of subcapsular enhancement on CEUS was higher than that of CECT(McNemar,P=0.028).Comparison of CEUS or CECT with gross specimens showed that there were statistical difference in intralesional hemorrhage area(CEUS vs gross pathology,P=0.045;CECT vs gross pathology,P=0.023).The consistency of the two methods and pathological examination results was low(CEUS vs gross,Kappa=0.327;CECT vs gross,Kappa=0.440).Based on“fast washin slow washout”and“subcapsular vascular enhancement”,the accuracy rate of CEUS was 47.6%,the accuracy of CECT was 33.3%,and the accuracy of combined methods was 52.4%.There was no statistical difference between the combined methods and CEUS alone.In total,12 inflammatory HCA(I-HCA)lesions were included in the study based on the results of immuno-histochemical staining.75.0%(8/12)of I-HCA showed overall enhancement in arterial phase on CEUS,41.7%(5/12)showed hypo-enhancement in late phase,and 41.7%(5/12)showed subcapsular enhancement,16.7%(2/12)showed unenhanced area.On CECT,33.3%(4/12)of I-HCA showed heterogeneous enhancement in the arterial phase,and 50.0%(6/12)showed washout in the late phase,subcapsular vascular enhancement was shown in 16.7%(2/12)of I-HCA,and 25.0%(3/12)showed unenhanced area.The detection rate of“hypoechoic on B-mode ultrasound,hyper-enhancement in arterial phase,and subcapsular vascular enhancement on CEUS”in I-HCA was about 41.7%,which could suggest I-HCA.Conclusions The accurate HCA diagnostic rate of CEUS is higher than CECT,and CEUS has more advantages in the display of enhancement pattern in arterial phase and subcapsular vascular enhancement.CECT combined with CEUS can improve the preoperative diagnosis accuracy of HCA.