CEUS定性定量参数在肝细胞肝癌和肝血管瘤鉴别诊断中的价值

The value of CEUS qualitative and quantitative parameters in the differential diagnosis of hepatocellular carcinoma and hepatic hemangioma

目的:探讨肝细胞肝癌、肝血管瘤的超声造影(CEUS)特征及其鉴别诊断价值。方法:选取我院2019年1月—2023年6月经病理学确诊的96例肝细胞肝癌和92例肝血管瘤进行病例对照分析,查阅两组患者治疗前的CEUS检查特征、时间-强度曲线(TIC)参数并绘制动态血管模式(DVP)曲线,以病理学结果为金标准计算CEUS鉴别诊断肝细胞肝癌和肝血管瘤的价值。结果:肝血管瘤的病灶长径、宽径均显著大于肝细胞肝癌,肝血管瘤病灶的高回声边缘检出率、病灶高回声检出率、边界清晰、后方回声增强患者占比均显著的高于肝细胞肝癌,上述指标的差异性均具有统计学意义(P<0.05);肝血管瘤的低回声晕检出率、病灶血流分布丰富率均显著低于肝细胞肝癌,差异均具有统计学意义(P<0.05);肝血管瘤的RT、TTP、MTT测定值均显著高于肝细胞肝癌,肝血管瘤的IMAX值低于肝细胞肝癌,上述实验室检查指标在两组之间差异具有显著性(P<0.05);肝血管瘤的正向波、负向波检出率均显著的高于肝细胞肝癌,肝血管瘤正负双向波检出率低于肝细胞肝癌,差异均具有统计学意义(P<0.05);超声特征诊断肝细胞肝癌的灵敏度为73.96%、特异度为70.65%、漏诊率为26.04%、误诊率为29.35%;TIC参数诊断肝细胞肝癌的灵敏度为84.38%、特异度为91.30%、漏诊率为15.63%、误诊率为8.70%;DVP曲线诊断肝细胞肝癌的灵敏度为82.29%、特异度为84.78%、漏诊率为17.71%、误诊率为15.22%。结论:CEUS检查的超声特征、TIC参数、DVP曲线特征对于鉴别诊断肝细胞肝癌和肝血管瘤有较高的灵敏度和特异度,具有较高的临床实用价值。

Objective:To explore the contrast-enhanced ultrasound(CEUS)features and differential diagnostic value of hepatocellular carcinoma and hepatic hemangioma.Methods:A case-control analysis was conducted on 96 cases of hepatocellular carcinoma and 92 cases of hepatic hemangioma diagnosed through pathological examination at our hospital from January 2019to June 2023.The CEUS examination characteristics,time intensity curve(TIC)parameters,and dynamic vascular pattern(DVP)curves of the two groups before treatment were reviewed,and the pathological results were used as the gold standard to calculate the value of CEUS in distinguishing hepatocellular carcinoma and hepatic hemangioma.Results:The length and width of lesions in hepatic hemangioma were significantly larger than those in hepatocellular carcinoma.The detection rate of high echogenic edges,high echogenic lesions,clear boundary and the proportion of patients with enhanced posterior echogenicity in hepatic hemangioma lesions were significantly higher than those in hepatocellular carcinoma.The differences in the above indicators were statistically significant(P<0.05).The detection rate of hypoechoic halo and the richness of lesion blood flow distribution in hepatic hemangioma were significantly lower than those in hepatocellular carcinoma,and the differences were statistically significant(P<0.05).The RT,TTP,and MTT values of hepatic hemangioma were significantly higher than those of hepatocellular carcinoma.The IMAX values of hepatic hemangioma were lower than those of hepatocellular carcinoma,and the differences were statistically significant(P<0.05).The detection rates of positive and negative waves in hepatic hemangioma were significantly higher than those in hepatocellular carcinoma.The detection rates of positive and negative bidirectional waves in hepatic hemangioma were lower than those in hepatocellular carcinoma,and the differences were statistically significant(P<0.05).The sensitivity of ultrasound features in diagnosing hepatic hemangioma and hepatocellular carcinoma is 73.96%,the specificity is 70.65%,the missed diagnosis rate is 26.04%,and the misdiagnosis rate is 29.35%.The sensitivity,specificity,missed diagnosis rate,and misdiagnosis rate of TIC parameters for diagnosing hepatic hemangioma and hepatocellular carcinoma were 84.38%,91.30%,15.63%,and 8.70%,respectively.The sensitivity,specificity,missed diagnosis rate,and misdiagnosis rate of DVP curve for diagnosing hepatic hemangioma and hepatocellular carcinoma were 82.29%,84.78%,17.71%,and15.22%,respectively.Conclusion:Based on the ultrasound features,TIC parameters,and DVP curve features of CEUS examination,it has high sensitivity and specificity for the differential diagnosis of hepatocellular carcinoma and hepatic hemangioma,and has high clinical practical value.