超声造影血管后相定量分析评估肝细胞癌分化程度

Quantitative analysis of the post-vascular phase of contrast-enhanced ultrasound in evaluating the differentiation of hepatocellular carcinoma

目的:探讨超声造影血管后相对肝细胞癌(HCC)分化程度的诊断价值。方法:回顾性分析2020年9月至2021年9月因肝脏占位性病灶于华中科技大学同济医学院附属同济医院就诊,术前1周内接受注射用全氟丁烷微球超声造影检查并经术后病理证实为HCC的115例患者的超声造影资料。根据病理结果,将病灶分为高分化组和低分化组,绘制感兴趣区域在超声造影动脉相及血管后相的时间-强度曲线,获取各定量参数数值,评价各定量参数鉴别两组病灶的诊断效能并计算截断值。结果:115例患者的117个病灶纳入本研究,其中高分化组70个病灶、低分化组47个病灶。高分化组与低分化组病灶在动脉相的始增时间、达峰时间、上升时间和峰值强度绝对值差异无统计学意义(均P>0.05);在血管后相(12 min),高分化组病灶增强强度绝对值、强度比及强度差低于低分化组,差异有统计学意义(均P<0.01);病灶增强强度绝对值<56.117 dB、强度比<1.212、强度差<9.184 dB鉴别HCC病灶为高分化组的敏感度和特异度分别为48.9%和80.0%,87.2%和77.1%、89.4%和75.7%。结论:超声造影血管后相的定量分析有助于鉴别HCC的分化程度,具有一定的临床应用价值。

Objective To investigate the diagnostic value of the post-vascular phase of contrast-enhanced ultrasound in the differentiation of hepatocellular carcinoma(HCC).Methods The contrast-enhanced ultrasound data of 115 patients who were admitted to Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology for liver space-occupying lesions from September 2020 to September 2021 were retrospectively analyzed.All patients underwent contrast-enhanced ultrasound with perfluorobutane microspheres for injection within 1 week before operation and were confirmed to be HCC by postoperative pathology.According to the pathological results,the lesions were divided into two groups—a well differentiated group and a poorly differentiated group.The time intensity curves of the regions of interest were drawn to obtain the quantitative parameters of arterial phase and the post-vascular phase.The diagnostic performance of each quantitative parameter in differentiating the two groups of lesions was evaluated and the cut-off value was calculated.Results 117 lesions from 115 patients were finally included in the study,including 70 lesions in the well differentiated group and 47 lesions in the poorly differentiated group.There were no significant differences in the initial growth time,peak time,rise time and the absolute value of peak intensity of lesions between the two groups in the arterial phase(all P>0.05).In the post-vascular phase(12 min),the absolute value of enhancement intensity,intensity ratio and intensity difference of the well differentiated group were lower than those in the poorly differentiated group,and the difference was statistically significant(all P<0.01).The sensitivity and specificity of the absolute value of enhancement intensity<56.117 dB,intensity ratio<1.212,intensity difference<9.184 dB to distinguish the HCC lesions as well-differentiated group were 48.9%and 80.0%,87.2%and 77.1%,89.4%and 75.7%,respectively.Conclusions The quantitative analysis of the post-vascular phase of contrast-enhanced ultrasound is helpful to identify the differentiation degree of HCC and has certain clinical application value.