超声造影鉴别诊断原发性小肝癌和肝硬化再生结节的临床价值

Clinical Value of Contrast-enhanced Ultrasonography in Differential Diagnosis of Primary Small Hepatocellular Carcinoma and Regenerative Nodules of Cirrhosis

目的:探究超声造影(CEUS)鉴别诊断原发性小肝癌与肝硬化再生结节的临床价值。方法:选取福建医科大学孟超肝胆医院2019年1月至2021年12月收治的原发性小肝癌40例和肝硬化再生结节40例患者,所有患者均接受CEUS检查,以病理学结果为衡量标准,计算CEUS对原发性小肝癌的诊断效能,并分析两组患者CEUS的时间–强度曲线,比较CEUS声像图特点。结果:以病理学结果为金标准,原发性小肝癌40例,共44个病灶,肝硬化再生结节40例,共49个病灶。CEUS检出原发性小肝癌40例,其阳性预测值、阴性预测值、灵敏度、特异度、准确度分别为95.23 %、92.16 %、90.91 %、95.92 %、93.55 %;原发性小肝癌组达峰时间、增强时间均短于肝硬化再生结节组,峰值强度、增强斜率均高于肝硬化再生结节组,差异具有统计学意义(P<0.05);两组患者动脉相的高、等、低增强者占比相比较,差异均具有统计学意义(P<0.05);而门脉相及延迟相的等、低增强者占比相比较,差异均具有统计学意义(P<0.05)。结论:CEUS对原发性小肝癌具有较高诊断效能,临床可根据CEUS特征、时间–强度曲线及其参数有效鉴别原发性小肝癌和肝硬化再生结节。

Objective To explore the clinical value of contrast-enhanced ultrasonography (CEUS) in differential diagnosis of primary small hepatocellular carcinoma and regenerative nodules of cirrhosis.Methods A total of 40 patients with small primary liver cancer and 40 patients with regenerative nodules of cirrhosis admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2019 to December 2021 were selected.All patients received CEUS examination,and the diagnostic efficacy of CEUS for small primary liver cancer was calculated based on pathological results.The time-intensity curves of CEUS in the two groups were analyzed,and the characteristics of CEUS sonogram were compared.Results According to the pathological results as the gold standard,there were 40 cases of primary small liver cancer (44 lesions) and 40 cases of liver cirrhosis regenerative nodules (49 lesions).The positive predictive value,negative predictive value,sensitivity,specificity and accuracy of 40 cases of small primary liver cancer detected by CEUS were 95.23%,92.16%,90.91%,95.92% and 93.55%,respectively.The peak time and enhancement time of primary small liver cancer group were shorter than those of the liver cirrhosis regenerative nodules group,and the peak intensity and enhancement slope were higher than those of the liver cirrhosis regenerative nodules group,the differences were statistically significant (P < 0.05).There were statistically significant differences in the proportion of high,equal and low enhancement in arterial phase between the two groups (P < 0.05).However,there were statistically significant differences in the proportion of equal and low enhancement in portal phase and delay phase (P < 0.05).Conclusion CEUS has high diagnostic efficiency for primary small hepatocellular carcinoma,and can effectively differentiate primary small hepatocellular carcinoma from regenerative nodules of cirrhosis according to CEUS characteristics,time-intensity curve and its parameters.