肝硬化背景下肝细胞肝癌、肝海绵状血管瘤的超声造影表现及相关参数

Contrast-enhanced ultrasound manifestations and related parameters of hepatocellular carcinoma and hepatic cavernous hemangioma in the context of liver cirrhosis

目的探讨肝硬化背景下肝细胞肝癌(HCC)、肝海绵状血管瘤(HCH)的超声造影表现及相关参数。方法选取143例肝硬化合并肝内结节样病灶患者,将82例肝硬化背景下HCC患者纳入HCC组,61例肝硬化背景下HCH患者纳入HCH组。观察两组患者的超声造影表现,比较两组患者的常规超声特征和超声造影参数,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析超声造影各参数对肝硬化背景下HCC的诊断效能。结果超声造影下,HCC组以快进快退、均匀增强为主,部分可见快进慢退和不均匀增强;HCH组以延迟期对比剂无或轻度退出、门脉期向心性填充、动脉期病变周围呈结节样环状强化为主。两组患者病灶边界、内部回声情况比较,差异均有统计学意义(P﹤0.01);HCC组病灶边界以模糊为主,内部回声以低回声、混合回声多见,而HCH组病灶边界以清晰为主,内部回声以高回声多见。HCC组患者的达峰时间(TTP)、平均通过时间(MTT)均明显短于HCH组,峰值强度(IMAX)明显高于HCH组,差异均有统计学意义(P﹤0.01)。两组患者动态血管模式(DVP)曲线特征比较,差异有统计学意义(P﹤0.01);HCC组患者DVP曲线特征以正负双向波为主,HCH组以正向波和负向波为主。ROC曲线显示,各参数单独诊断时以TTP诊断肝硬化背景下HCC的AUC最大,为0.817(95%CI:0.735~0.899),其次为IMAX、MTT,三者联合诊断肝硬化背景下HCC的AUC为0.833(95%CI:0.756~0.909),高于各参数单独诊断。结论超声造影可清晰显示肝硬化背景下HCC、HCH,超声造影特征及相关参数可有效鉴别诊断肝硬化背景下HCC、HCH,临床应用价值较高。

Objective To explore the contrast-enhanced ultrasound manifestations and related parameters of hepatocellular carcinoma(HCC)and hepatic cavernous hemangioma(HCH)in the context of liver cirrhosis.Method A total of 143 patients with liver cirrhosis and intrahepatic nodular lesions were selected,82 cases of patients with HCC in the context of liver cirrhosis were enrolled into the HCC group and 61 cases of patients with HCH into the HCH group.The contrast-enhanced ultrasound manifestations of the two groups were observed,the conventional ultrasound characteristics and contrast-enhanced ultrasound parameters were compared,and receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the diagnostic efficiency of contrast-enhanced ultrasound parameters for HCC in the context of liver cirrhosis.Result Under contrast-enhanced ultrasound,fast forward and fast retreat and uniform enhancement were the main features in the HCC group,and fast forward and slow retreat and uneven enhancement were partially visible;in the HCH group,there was no or slight withdrawal of contrast medium in the delayed phase,concentric filling in the portal phase,and nodular ring enhancement around the lesion in the arterial phase.There were significant differences for the lesion boundary and internal echoes between the two groups(P<0.01);in the HCC group,the boundary was mainly fuzzy,and the internal echoes were mostly hypoechoic and mixed echoes,on the contrary,the HCH group showed clear boundary and mainly hyperechoic internal echoes.The time to peak(TTP)and mean transit time(MTT)of the HCC group were shorter than those of the HCH group,and maximum intensity(IMAX)was significantly higher than that of the HCH group(P<0.01).There was significant difference for the characteristics of dynamic vascular pattern(DVP)curve between the two groups(P<0.01);the characteristics of DVP curve in the HCC group were mainly positive and negative bidirectional waves,while those in the HCH group were mainly positive and negative waves.The re sults of ROC showed that in the individual diagnosis of each parameter,TTP had the largest AUC for the diagnosis of HCC in the context of liver cirrhosis,which was 0.817(95%CI:0.735-0.899),followed by IMAX and MTT.The AUC of combined diagnosis(TTP+IMAX+MTT)was 0.833(95%CI:0.756-0.909),which was higher than the individual diagnosis of each parameter.Conclusion Contrast-enhanced ultrasound can clearly display HCC and HCH in the context of liver cirrhosis,and imaging characteristics and related parameters can effectively differential diagnose HCC and HCH in the context of liver cirrhosis,which has high clinical application value.