结节性肝癌与肝局灶性结节性增生的常规超声及超声造影对比及鉴别诊断

Ultrasonographic and Contrast-Enhanced Ultrasonographic Features of Nodular Hepatocellular Carcinoma and Focal Nodular Hyperplasia and Their Diagnostic Values

目的:对比分析结节性肝癌(nodular hepatocellular carcinoma, NHCC)及局灶性结节性增生(focal nodular hyperplasia, FNH)的常规超声及超声造影特征,分析超声造影的鉴别诊断价值。方法:采用回顾性分析,纳入我院2017年1月至2021年6月期间收治的42例NHCC患者和42例FNH患者,收集其影像学等资料,对比NHCC与FNH患者二维超声特征和超声造影特征的差异。结果:NHCC患者淋巴结肿大、肝硬化、门静脉癌栓占比较FNH患者高,中心瘢痕、病灶位于肝包膜下的发生率均较FNH组患者低,差异均有统计学意义(P<0.05)。NHCC组患者门脉相以低增强为主,FNH组则以等增强为主,差异有统计学意义(P<0.05);两组患者延迟相均以低增强为主,但NHCC组低增强发生率较FNH组更高,差异有统计学意义(P<0.05)。NHCC组患者PI较FNH组大,mTT、TTP、RT均较FNH组低,差异均有统计学意义(P<0.05)。超声造影诊断NHCC的灵敏度为95.24%、特异性为95.24%。结论:NHCC与FNH患者在常规超声特征和超声造影特征上有明显差异,增加超声造影参数分析能进一步鉴别此二种病变,为临床治疗提供指导。

Objective: To compare the values of ultrasonographic and contrast-enhanced ultrasonographic features in the diagnosis of nodular hepatocellular carcinoma(NHCC) and focal nodular hyperplasia(FNH). Methods: A retrospective analysis was performed to enroll 42 patients with NHCC and 42 patients with FNH who were admitted to our hospital from January 2017 to June 2021. The imaging data were analyzed. Ultrasonographic and contrast-enhanced ultrasonographic features in NHCC and FNH groups were compared. Results: The incidences of lymphadenopathy, cirrhosis and portal vein tumor thrombus in the NHCC group were significantly higher than those in the FNH group, and the incidences of central scar and subcapsular lesions in the former were significantly lower than those in latter(P<0.05). The NHCC group showed low enhancement in the portal vein, while the FNH group showed iso-enhancement;and the difference was statistically significant(P<0.05). The delayed phase in both groups showed low enhancement which was significantly higher in the NHCC group than in the FNH group(P<0.05). Perfusion index in the NHCC group was significantly greater than that in the FNH group, and mean transit time, time to peak and rise time in the former were significantly lower than those in the latter(P<0.05). The specificity and sensitivity of contrast-enhanced ultrasonography in the diagnosis of NHCC were 95.24% and 95.24%. Conclusion: Ultrasonographic features differs from contrast-enhanced ultrasonographic features significantly in the diagnosis of NHCC and FNH. Contrast-enhanced ultrasound parameters added to ultrasonographic features can further identify these two types of lesions, which provides guidance for clinical treatment.