超声造影各期增强特点在肝内胆管细胞癌与肝细胞癌、肝血管瘤鉴别诊断中的价值

The value of CEUS enhancement characteristics in the differential diagnosis of intrahepatic cholangiocarcinoma, hepatocellular carcinoma and hepatic hemangioma

目的 探讨超声造影(CEUS)在肝内胆管细胞癌、肝细胞癌、肝血管瘤鉴别诊断中的价值。方法 选取肝脏占位性病变患者157例,其中肝内胆管细胞癌患者41例,肝细胞癌患者50例,肝血管瘤患者66例,比较各组CEUS图像特征及定量参数差异。结果 肝内胆管细胞癌形态不规则、病灶边界模糊、动脉期非均匀增强和门静脉期低增强比例分别为65.85%、53.66%、90.24%和100.00%,明显高于肝细胞癌和肝血管瘤(P<0.05);肝内胆管细胞癌和肝细胞癌延迟期低增强比例分别为100.00%和94.00%,明显高于肝血管瘤(P<0.05);肝细胞癌病灶边界模糊、门静脉低增强比例分别为12.00%和68.00%,明显高于肝血管瘤(P<0.05);肝内肝管细胞癌始增时间和达峰时间分别为(8.89±1.95)s和(18.65±7.11)s,明显快于肝细胞癌和肝血管瘤(P<0.05);肝细胞癌始增时间和达峰时间分别为(10.82±2.21)s和(22.15±8.36)s,明显快于肝血管瘤(P<0.05);始增时间、达峰时间鉴别诊断肝内胆管细胞癌、肝血管瘤的ROC曲线下面积均高于0.800,P<0.05。结论 肝内胆管细胞癌、肝细胞癌和肝血管瘤CEUS图像特征有所差异,同时CEUS可为鉴别诊断提供定量参数。

Objective To explore the value of contrast-enhanced ultrasound(CEUS)in the differential diagnosis of intrahepatic cholangiocarcinoma(ICC),hepatocellular carcinoma(HCC),and hepatic hemangioma(HH).Methods 157 patients with liver space occupying lesions were selected,including 41 patients with ICC,50 patients with HCC,and 66 patients with HH.The differences in CEUS image characteristics and quantitative parameters were pairwise compared.Results The proportions of irregular morphology,blurred lesion boundaries,uneven enhancement in arterial phase,and low enhancement in portal vein phase in ICC were 65.85%,53.66%,90.24%,and 100.00%,respectively,which were significantly higher than those with HCC and HH(all P<0.05).The proportion of delayed low enhancement in ICC and HCC was 100.00%and 94.00%,respectively,which were significantly higher than that in HH(both P<0.05).The rates of blurred border and low enhancement of portal vein in HCC were 12.00%and 68.00%,respectively,which were significantly higher than those in HH(both P<0.05).The initial time of enhancement,the time of reaching peak in ICC were(8.89±1.95)s and(18.65±7.11)s,respectively,which were significantly faster than those in HCC and HH(all P<0.05).The initial time of enhancement,time of reaching peak in HCC were(10.82±2.21)s and(22.15±8.36)s,respectively,which were significantly faster than those in HH(all P<0.05).The area under the ROC curves for differential diagnosis of ICC and HH by the onset time and peak time were higher than 0.800(P<0.05).Conclusion The CEUS image characteristics of ICC,HCC,and HH are different,and CEUS can provide quantitative parameters for differential diagnosis.