采用超声造影灌注及回声变化规律鉴别诊断肝血管瘤与肝细胞癌价值研究

Differential diagnosis of hepatocellular carcinoma and hepatic hemangioma by contrast-enhanced ultrasonography

目的探讨超声造影(CEUS)鉴别诊断肝血管瘤(HCH)与肝细胞癌(HCC)的价值。方法2020年1月~2021年12月我院诊治的75例肝内占位性病变患者,经肝穿刺活检或手术组织病理学检查诊断,所有患者均接受CEUS检查,绘制受试者工作特征曲线(ROC)分析CEUS参数鉴别HCH与HCC的效能。结果病理学检查诊断HCH 35例和HCC 40例;HCC病灶边界清晰、高回声和回声均匀比率分别为17.5%、22.5%和12.5%,均显著低于HCH病灶(分别为65.7%、65.7%和74.3%,P<0.05),而II级血流信号占比为67.5%,显著高于HCH病灶的14.3%(P<0.05);增强扫描HCC病灶动脉期呈高增强占比为65.0%,显著低于HCH病灶的91.4%,而门静脉期和延迟期病灶呈低增强占比分别为70.0%和90.0%,显著高于HCH病灶的8.6%和42.8%(P<0.05);HCC病灶始增时间、达峰时间和增强速率分别为(9.6±1.8)s、(25.8±4.1)s和(0.5±0.1),显著快于HCH病灶【分别为(13.2±2.5)s、(32.3±6.7)s和(0.9±0.2),P<0.05】;ROC曲线分析显示,应用始增时间、达峰时间和增强速率联合鉴别诊断HCC的曲线下面积(AUC)为0.935,其灵敏度为82.8%,特异度为90.0%,显著优于指标单独鉴别(P<0.05)。结论使用CEUS灌注和回声变化参数鉴别诊断HCH与HCC具有较大的临床价值。

Objective This study was conducted to explore the differential diagnosis of hepatocellular carcinoma(HCC)and hepatic hemangioma(HCH)by contrast-enhanced ultrasonography(CEUS).Methods 75 patients with intrahepatic space-occupying lesions were enrolled in our hospital between January 2020 and December 2021,and all underwent CEUS before liver histopathological diagnosis was made.The receiver operating characteristic(ROC)curves was applied to reveal the diagnostic performance of parameters by CEUS in differentiating HCC from HCH.Results The histopathological examination showed HCH in 35 cases and HCC in 40 cases in our series;the percentages of clear boundary,high echo and uniform internal echo in HCC lesions were 17.5%,22.5%and 12.5%,all significantly lower than 65.7%,65.7%and 74.3%(P<0.05),while the percentage of grade II blood flow signal was 67.5%,much higher than 14.3%(P<0.05)in HCH lesions;the CEUS demonstrated that the proportions of high enhancement during arterial stage in HCC lesions was 65.0%,much lower than 91.4%in HCH lesions,while the proportions of low enhancement during portal and delayed stage were 70.0%and 90.0%,both significantly higher than 8.6%and 42.8%(P<0.05)in HCH foci;the starting time of enhancement,time to peak and enhancement rate in HCC lesions were(9.6±1.8)s,(25.8±4.1)s and(0.5±0.1),all significantly quicker than[(13.2±2.5)s,(32.3±6.7)s and(0.9±0.2),respectively,P<0.05]in HCH foci;the ROC analysis showed the AUC was 0.935,with the sensitivity of 82.8%and the specificity of 90.0%,when the combination of the starting time of enhancement,time to peak and enhancement rate was applied to predict the differentiation of HCC from HCH,much superior to any parameter done alone(P<0.05).Conclusion The perfusion and echo changes during CEUS could provide reliable ultrasonic imaging basis for the differential diagnosis of HCH from HCC,and warrants further clinical investigation.