超声造影对小肝癌微血管侵犯的预测价值

The value of contrast-enhanced ultrasound in predicting microvascular invasion of small hepatocellular carcinoma

目的分析小肝癌(sHCC)超声造影(CEUS)特征与微血管侵犯(MVI)的相关性并评估其对sHCC患者MVI的预测价值。方法回顾性分析113例行手术切除的sHCC患者资料,其中MVI阳性组39例,MVI阴性组74例,术前1周内均行CEUS检查。比较两组的临床资料、超声及CEUS相关特征,分析sHCC患者MVI的影响因素及其预测价值。结果与MVI阴性组相比,MVI阳性组AFP水平较高、瘤周有低回声晕、肿瘤边缘不光滑比例较高、开始廓清时间较早(P<0.05)。多因素logistic回归分析显示,肿瘤边缘不光滑、开始廓清时间较早是sHCC患者MVI的独立危险因素,受试者工作特征(ROC)曲线分析显示其曲线下面积(AUC)为0.807。开始廓清时间以107 s为预测sHCC患者存在MVI的最佳临界值,敏感度及特异度分别为69.20%、75.70%。结论超声及超声造影特征与sHCC患者MVI有一定的相关性,肿瘤边缘不光滑及开始廓清时间较早是sHCC患者MVI的独立危险因素,对sHCC患者是否存在MVI具有重要的预测价值。

Objective To analyze the correlation between the features of contrast-enhanced ultrasound(CEUS)and microvascular invasion(MVI)of small hepatocellular carcinoma(sHCC),and to evaluate the predictive value for MVI in patients with sHCC.Methods The data of 113 patients with sHCC who underwent surgical resection in our hospital were retrospectively analyzed,including 39 patients in the MVI positive group and 74 patients in the MVI negative group.All patients were examined by CEUS within 1 week before operation.The clinical data,ultrasound and CEUS characteristics between the two groups were compared to analyze the influencing factors ofMVI in sHCC patients and the predictive value of MVI.Results Compared with the MVI negative group,the MVI positive group had higher AFP level,higher proportion of peritumoral hypoechoic halo and unsmooth tumor margin,as well as the earlier clearance time(P<0.05).Multivariate logistic regression analysis showed that the unsmooth tumor margin and earlier clearance time were the independent risk factors for predicting MVI in sHCC patients.The receiver operating characteristic(ROC)curve analysis indicated that the area under curve(AUC)was 0.807.Using the clearance time was 107 s as the cut-off value for predicting MVI of sHCC,the sensitivity and specificity were 69.20%and 75.70%,respectively.Conclusion The characteristics of ultrasound and contrast-enhanced ultrasound are correlated with MVI in patients with sHCC.The unsmooth tumor margin and earlier clearance time are the independent risk factors for predicting MVI in patients with sHCC and which had an important predictive value for the existence of MVI.