影像学检查在诊断小肝癌中的应用价值

Application value of imaging examinations in the diagnosis of small hepatocellular carcinoma

目的探讨超声造影、增强CT、增强磁共振成像(MRI)检查在诊断小肝癌中的应用价值。方法采用临床诊断性试验研究方法。收集2019年1月至2021年6月陆军军医大学第一附属医院收治的145例小肝癌患者的临床病理资料;男121例, 女24例;中位年龄为54岁, 年龄范围为26~78岁。患者均行超声造影、增强CT、增强MRI检查, 1个月内行手术切除病灶。观察指标:(1)小肝癌患者术后组织病理学检查情况。(2)小肝癌超声造影、增强CT、增强MRI检查情况。(3)小肝癌超声造影、增强CT、增强MRI检查影像学特征。(4)小肝癌超声造影、增强CT、增强MRI检查动脉期、门静脉期、延迟期强化方式分布。(5)小肝癌超声造影、增强CT、增强MRI检查的诊断效能。正态分布的计量资料以x±s表示, 偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示, 组间比较采用Cochran′sQ检验或χ^(2)检验。采用灵敏度、特异度、准确度分析超声造影、增强CT、增强MRI检查对小肝癌的诊断效能。结果 (1)小肝癌患者术后组织病理学检查情况。145例小肝癌患者术后组织病理学检出154个病灶, 肿瘤长径为(2.2±0.6)cm。(2)小肝癌超声造影、增强CT、增强MRI检查情况。145例小肝癌患者超声造影、增强CT、增强MRI检查检出肝脏病灶数目分别为153个、154个、154个, 检出率分别为99.35%(153/154)、100.00%(154/154)、100.00%(154/154), 3种影像学检查小肝癌病灶检出率比较, 差异无统计学意义(Q=2.00, P>0.05)。(3)小肝癌超声造影、增强CT、增强MRI检查影像学特征。153个超声造影检查检出小肝癌病灶中, 表现为"快进快出"强化方式140个, "快进慢出"强化方式12个, "等-低-低"强化方式1个。154个增强CT检查检出小肝癌病灶中, 表现为"快进快出"强化方式112个, "快进慢出"强化方式13个, "等-低-低"强化方式14个, "环状高-低-低""低-低-低"强化方式各5个, "高-高-高"强化方式3个, "等-等-等""等-等-低"强化方式各1个。154个增强MRI检查检出小肝癌病灶中, 表现为"快进快出"强化方式134个, "快进慢出"强化方式1个, "等-低-低"强化方式8个, "环状高-低-低"强化方式5个, "持续性环状高"强化方式2个, "高-高-高""低-低-低""等-等-低""边缘延迟强化"强化方式各1个。(4)小肝癌超声造影、增强CT、增强MRI检查动脉期、门静脉期、延迟期强化方式分布。153个超声造影检查检出小肝癌病灶中, 动脉期高强化152个、等或低强化1个, 门静脉期高或等强化55个、低强化98个, 延迟期高或等强化12个、低强化141个。154个增强CT检查检出小肝癌病灶中, 动脉期高强化133个、等或低强化21个, 门静脉期高或等强化53个、低强化101个, 延迟期高或等强化17个、低强化137个。154个增强MRI检查检出小肝癌病灶中, 动脉期高强化143个、等或低强化11个, 门静脉期高或等强化29个、低强化125个, 延迟期高或等强化5个、低强化149个。小肝癌病灶超声造影、增强CT、增强MRI检查中动脉期、门静脉期、延迟期强化方式分布数目比较, 差异均有统计学意义(χ^(2)=19.47, 13.21, 6.92, P<0.05)。(5)小肝癌超声造影、增强CT、增强MRI检查的诊断效能。153个超声造影检查诊断小肝癌病灶中, 经术后组织病理学检查结果核对误诊病灶3个。154个增强CT、增强MRI检查诊断小肝癌病灶中, 经术后组织病理学检查结果核对误诊病灶分别为7个、2个。单一影像学检查误诊的病灶均在其他两项影像学检查中获得正确诊断。超声造影检查诊断小肝癌的灵敏度、特异度、准确度分别为97.4%、63.0%、92.3%, 增强CT和增强MRI检查的上述指标分别为95.5%、63.0%、90.6%和98.7%、63.0%、93.4%;3种影像学检查方式上述指标比较, 差异均无统计学意义(Q=2.92, 0.00, 1.81, P>0.05)。结论超声造影、增强CT、增强MRI检查对小肝癌均有较好诊断价值, 3种影像学检查方式诊断小肝癌具有互补效果。

Objective To investigate the application value of contrast-enhanced ultra-sound,enhanced computed tomography(CT)and enhanced magnetic resonance imaging(MRI)in the diagnosis of small hepatocellular carcinoma.Methods The clinical diagnositic trial was con-ducted.The clinicopathological data of 145 patients with small hepatocellular carcinoma who were admitted to the First Affiliated Hospital of Amy Medical University from January 2019 to June 2021 were collected.There were 121 males and 24 females,aged from 26 to 78 years,with a median age of 54 years.All patients were examined with contrast-enhanced ultrasound,enhanced CT and enhanced MRI,and underwent surgical resection of liver lesions within one month.Observation indicators:(1)postoperative histopathological examinations of patients with small hepatocellular carcinoma;(2)examination of small hepatocellular carcinoma by contrast-enhanced ultrasound,enhanced CT and enhanced MRI;(3)imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound,enhanced CT and enhanced MRI;(4)enhancement mode distribution of small hepatocellular carcinoma in the arterial,portal and delayed phases of contrast-enhanced ultrasound,enhanced CT and enhanced MRI;(5)the efficacy of contrast-enhanced ultrasound,enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the Cochran′s Q test or the chi-square test.The sensitivity,specificity and accuracy were used to analyze the efficacy of contrast-enhanced ultrasound,enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma.Results(1)Postoperative histopathological examinations of patients with small hepatocellular carcinoma.There were 154 lesions detected in the postoperative histopathological examinations for the 145 small hepatocellular carcinoma patients,with the tumor diameter as(2.2±0.6)cm.(2)Examination of small hepatocellular carcinoma by contrast-enhanced ultrasound,enhanced CT and enhanced MRI.There were 153,154 and 154 lesions detected in contrast-enhanced ultrasound,enhanced CT and enhanced MRI for the 145 patients with small hepatocellular carcinoma,respectively,with the detection rate as 99.35%(153/154),100.00%(154/154)and 100.00%(154/154),showing no significant difference among the 3 imaging examination methods(Q=2.00,P>0.05).(3)Imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound,enhanced CT and enhanced MRI.Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma,140 lesions showed"fast-in and fast-out"enhancement,12 lesions showed"fast-in and slow-out"enhancement and 1 lesion showed isoenhancement in arterial phases and hypoenhancement in portal and delayed phase.Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma,112 lesions showed"fast-in and fast-out"enhancement,13 lesions showed"fast-in and slow-out"enhancement,14 lesions showed isoenhancement in arterial phase and hypoenhancement in portal and delayed phases,5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delayed phases,5 lesions showed hypoenhancement in the three phases,3 lesions showed hyperenhancement in the three phases,1 lesion showed isoenhancement in the three phases and 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed phase.Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma,134 lesions showed"fast-in and fast-out"enhancement,1 lesion showed"fast-in and slow-out"enhancement,8 lesions showed isoenhancement in arterial phase and hypoenhance-ment in portal and delayed phases,5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delay phases,2 lesions showed rim-like hyperenhancement in the three phases,1 lesion showed hyperenhancement in the three phases,1 lesion showed hypoenhancement in the three phases,1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed late phase,1 lesion showed edge delay enhancement in the three phases.(4)Enhancement mode distribution of small hepatocellular carcinoma in the arterial,portal and delayed phases of contrast-enhanced ultrasound,enhanced CT and enhanced MRI.Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma,there were 152 lesions with hyperenhancement and 1 lesion with iso or hypoenhance-ment in the arterial phase,there were 55 lesions with hyper or isoenhancement and 98 lesions with hypoenhancement in the portal venous phase,there were 12 lesions with hyper or isoenhancement and 141 lesions with hypoenhancement in the delayed phase.Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma,there were 133 lesions with hyperen-hancement signal and 21 lesions with iso or hypoenhancement in the arterial phase,there were 53 lesions with hyper or isoenhancement and 101 lesions with hypoenhancement in the portal phase,there were 17 lesions with hyper or isoenhancement and 137 lesions with hypoenhancement in the delayed phase.Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma,there were 143 lesions with hyperenhancement and 11 lesions with iso or hypoenhance-ment in the arterial phase,there were 29 lesions with hyper or isoenhancement and 125 lesions with hypoenhancement in the portal phase,there were 5 lesions with hyper or isoenhancement and 149 lesions with hypoenhancement in the delayed phase.There were significant differences in the enhancement mode distribution of lesions in the arterial,portal and delayed phases among contrast-enhanced ultrasound,enhanced CT and enhanced MRI(χ²=19.47,13.21,6.92,P<0.05).(5)The efficacy of contrast-enhanced ultrasound,enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma.Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma,there were 3 lesions misdiagnosed according to the postoperative histopathological examinations.Of the 154 lesions reported in enhanced CT and enhanced MRI for patients with small hepatocellular carcinoma,there were 7 lesions and 2 lesions misdiagnosed according to the postoperative histopathological examinations,respectively.Lesions misdiagnosed in one imaging examination method were correctly diagnosed in the other two imaging examination methods.The sensitivity,specificity,accuracy were 97.4%,63.0%,92.3%for contrast-enhanced ultrasound in the diagnosis of small hepatocellular carcinoma.The above indica-tors were 95.5%,63.0%,90.6%for enhanced CT and 98.7%,63.0%,93.4%for enhanced MRI in the diagnosis of small hepatocellular carcinoma.There was no significant difference in the sensitivity and accuracy among the 3 imaging examination methods(Q=2.92,0.00,1.81,P>0.05).Conclusion Contrast-enhanced ultrasound,enhanced CT and enhanced MRI all have good diagnostic value in diagnosis of small hepatocellular carcinoma,and they complement each other.