超声造影与增强CT检查诊断小肝癌效能比较

Comparison of diagnostic efficacy of contrast-enhanced ultrasound and enhanced CT scan in patients with small hepatocellular carcinoma

目的分析比较超声造影(CEUS)与增强CT诊断对小肝细胞癌(HCC)的效能。方法2020年1月~2022年6月我院诊治的104肝脏小结节患者,病灶直径≤3.0 cm。均接受CEUS和增强CT检查,以穿刺活检或手术组织病理学检查诊断。应用2018年版肝脏影像报告和数据系统(LI-RADS)对肝脏小结节分类,分析CEUS与增强CT诊断小肝癌的效能。结果CEUS与增强CT对肝脏小结节分类有93例(89.4%)一致,一致性良好(Kappa系数=0.749,P<0.05);在104肝脏小结节患者中,经病理学检查明确诊断为HCC者42例(高分化29例,低分化13例),肝脏良性结节62例;Kappa一致性检验显示,CEUS与增强CT诊断小肝癌均有较高的效能(P均<0.05),CEUS与增强CT以LR-4/LR-5为判断HCC的标准,与金标准诊断的一致性较高(Kappa=0.861和Kappa=0.803),显示CEUS的诊断效能稍优于增强CT诊断;高分化HCC患者CEUS检查达峰时间和开始廓清时间分别为(29.4±4.8)s和(62.4±5.7)s,均显著长于低分化者【分别为(25.0±4.3)s和(51.8±5.2)s,P均<0.05】。结论CEUS和增强CT检查诊断小肝癌均有较高的效能,在某些情况下,CEUS检查可能更具优越性,对评估肿瘤细胞分化程度可能有帮助。

Objective The aim of this study was to compare the diagnostic efficacy of contrast-enhanced ultrasound(CEUS)and enhanced CT scan in patients with small hepatocellular carcinoma(sHCC).Methods 104 patients with intrahepatic nodules with diameter of less than 3.0 cm were encountered in our hospital between January 2020 and June 2022,and all underwent CEUS and enhanced CT scan.The gold diagnostic criteria was based on fine needle aspiration biopsies and/or histopathological examination after operation.The 2018 edition Liver Imaging Reporting and Data System(LI-RADS)was applied to classify the hepatic nodules,and the diagnostic efficacy of CEUS and enhanced CT scan was compared by Kappa coefficient.The differences in CEUS quantitative parameters including initial enhancement time,peak time and initial clearance time was compared too.Results The classification of CEUS and enhanced CT scan was consistent in 93 cases(89.4%)in patients with intrahepatic nodules,showing a good consistency(Kappa coefficient=0.749,P<0.05);there were 42 cases with sHCC(including highly differentiated in 29 cases and poorly differentiated in 13 cases)and 62 cases with small benign hepatic nodules among our 104 patients finally confirmed by pathological examination;the Kappa consistency test showed that both the CEUS and enhanced CT scan had good diagnostic efficacy in diagnosing sHCC(P<0.05),and the diagnostic consistencies of CEUS and enhanced CT scan with gold criteria were good when the LR-4/LR-5 was defined as HCC(Kappa=0.861 and Kappa=0.803),suggesting the CEUS was relatively superior to CT scan;the peak time and initial clearance time in patients with highly-differentiated sHCC were(29.4±4.8)s and(62.4±5.7)s,both significantly longer than[(25.0±4.3)s and(51.8±5.2)s,respectively,P<0.05]in those with poorly-differentiated patients.Conclusion Both the CEUS and enhanced CT scan have a good diagnostic efficacy in diagnosing sHCC,and the CEUS might be superior under certain circumstance,which provide more information for tumor classification.