超声对新生儿肝脏肿瘤的鉴别诊断价值

Value of ultrsound to the differential diagnosis of liver tumors in neonates

目的观察新生儿肝脏肿瘤超声、CT、MRI影像学特征,探讨超声对新生儿肝脏肿瘤的鉴别诊断价值。方法29例肝脏肿瘤新生儿均行超声检查,其中21例行CT检查,16例行MRI检查。以组织病理检查结果或每月随访至瘤体缩小消退为诊断金标准,将29例患儿分为肝血管瘤组19例和其他肝脏肿瘤组10例,比较2组性别比例、血清甲胎蛋白水平、超声声像图特征;根据诊断金标准,比较超声、CT、MRI诊断新生儿肝脏肿瘤的准确率;采用Kappa检验评价超声与诊断金标准诊断新生儿肝脏肿瘤的一致性。结果29例患儿中肝血管瘤19例,肝母细胞瘤6例,神经母细胞瘤肝转移2例,肝间叶性错构瘤1例,肝脓肿1例。肝血管瘤组女性及畸形增粗血管、钙化、低阻丰富血流(瘤体内血流阻力指数<0.7)比率(63.16%、52.63%、42.11%、89.47%)均高于其他肝脏肿瘤组(40.00%、0、10.00%、30.00%)(P<0.05),血清甲胎蛋白水平[10545.0(4378.0,18840.0)μg/L]与其他肝脏肿瘤组[28693.2(4872.5,28693.5)μg/L]比较差异无统计学意义(U=-1.079,P=0.281)。超声诊断新生儿肝脏肿瘤的准确率(82.76%)高于CT(66.67%)、MRI(75.00%)(χ^(2)=54.713,P<0.001;χ^(2)=8.455,P=0.009),MRI高于CT(χ^(2)=7.184,P=0.008)。超声诊断新生儿肝脏肿瘤与诊断金标准的一致性较好(Kappa=0.883,P<0.001)。结论新生儿肝脏肿瘤中肝血管瘤常见,女性多发,畸形增粗血管、钙化及低阻丰富血流是其超声声像图特征,超声对新生儿肝脏肿瘤的鉴别诊断价值较高。

Objective To observe the characteristics of ultrasound,CT and MRI images of liver tumors in neonates,and to explore the value of ultrasound to the differential diagnosis of liver tumors in neonates.Methods Twenty-nine neonates with liver tumors received ultrasound,besides which 21received CT examination and 16received MRI examination.Taking the histopathological examination result or monthly follow-up till the shrinking and fading of tumor body as the gold standard,29neonates were divided into hepatic hemangioma group(n=19)and other liver tumor group(n=10).The gender ratio,serum alpha fetoprotein level and ultrasonic ultrasonographic features were compared between two groups.According to the diagnostic gold standard,the accuracies of ultrasound,CT and MRI for diagnosing neonatal liver tumors were also compared between two groups.Kappatest was employed to analyze the consistency of ultrasonic diagnosis of neonatal liver tumors with the gold standard.Results In 29neonates,there were 19cases of hepatic hemangioma,6of hepatoblastoma,2of liver metastasis from neuroblastoma,1of hepatic mesenchymal hamartoma,and 1of liver abscess.The percentages of female neonates and percentages of malformation&thickened blood vessels,calcification,and low resistance&rich blood flow(blood flow resistance index<0.7)were higher in hepatic hemangioma group(63.16%,52.63%,42.11%,89.47%)than those in other liver tumor group(40.00%,0,10.00%,30.00%)(P<0.05),and there was no significant difference in alpha fetoprotein level between hepatic hemangioma group[10545.0(4378.0,18840.0)μg/L]and other liver tumor group[28693.2(4872.5,28693.5)μg/L](U=-1.079,P=0.281).The accuracy of ultrasound in diagnosing liver tumors in neonates(82.76%)was higher than that of CT(66.67%)and MRI(75.00%)(χ^(2)=54.713,P<0.001;χ^(2)=8.455,P=0.009),and higher of MRI than that of CT(χ^(2)=7.184,P=0.008).The ultrasonic diagnosis of liver tumors in neonates was consistent with the gold standard(Kappa=0.883,P<0.001).Conclusions Hepatic hemangioma is common in liver tumors in neonates.It often occurs in females,and is ultrasonically characterized by abnormal thickening of blood vessels,calcification as well as low resistance and rich blood flow.Ultrasound possesses a high value to the differential diagnosis of liver tumors in neonates.