肝脏炎性病灶与原发性肝细胞癌的超声造影表现比较及廓清时间影响因素分析

A comparison between the contrast-enhanced ultrasound manifestations of inflammatory liver lesions and primary hepatocellular carcinoma and analysis of the factors affecting clearance time

目的分析肝脏炎性病灶与原发性肝细胞癌的超声造影表现比较及廓清时间影响因素。方法2017年6月—2022年6月成都医学院第二附属医院经病理学检查确诊的30例肝脏炎性病灶患者和50例原发性肝细胞癌患者,比较两种疾病的超声造影表现和超声造影定量参数,应用受试者工作特征曲线(ROC)分析超声造影定量参数对肝脏炎性病灶和原发性肝细胞癌的鉴别诊断价值。结果肝脏炎性病灶动脉相增强形态不规则、边界不清晰、门脉相低增强占比分别为60.0%、80.0%、80.0%,与原发性肝细胞癌(16.0%、6.0%、40.0%)相比,差异具有统计学意义(P<0.05)。肝脏炎性病灶下降时间、平均通行时间、开始廓清时间分别为(31.7±3.4)s、(18.2±2.1)s、(63.4±7.1)s,与原发性肝细胞癌(46.1±5.2)s、(34.3±3.7)s、(35.1±3.8)s比,差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,下降时间、平均通行时间、开始廓清时间在鉴别诊断肝脏炎性病灶和原发性肝细胞癌中具有较高价值。结论超声造影检查在鉴别诊断肝脏炎性病灶和原发性肝细胞癌中具有一定价值,超声造影定量分析可客观显示肝脏炎性病灶和原发性肝细胞癌的血流灌注特征,进而阐明二者廓清时间差异原因。

Objective To analyze the differences of contrast-enhanced ultrasound(CEU)manifestations between liver inflammatory lesions and primary hepatocellular carcinoma(PHC),as well as the influencing factors of clearance time.Methods Between June 2017 and June 2022,30 patients with hepatic inflammatory lesions and 50 patients with PHC were diagnosed with pathology in Chengdu Medical College Second Affiliated Hospital.The CEU manifestations and quantitative CEU parameters of the two diseases were compared,and the value of quantitative CEU parameters in the differential diagnosis of hepatic inflammatory lesions and PHC was analyzed using the receiver operating characteristic curve(ROC).Results The proportion of irregular arterial phase enhancement,unclear boundaries,and low portal phase enhancement in liver inflammatory lesions was 60.0%,80.0%,and 80.0%,respectively.The difference was statistically significant compared to PHC(16.0%,6.0%,and 40.0%)(P<0.05).The descending time,average passage time,and initial clearance time of liver inflammatory lesions were(31.7±3.4)s,(18.2±2.1)s,and(63.4±7.1)s,respectively,the differences were statistically significant when compared to those of(46.1±5.2)s,(34.3±3.7)s,and(35.1±3.8)s in PHC patients(P<0.05).The ROC curve analysis results show that the descent time,average passage time,and start clearance time have high value in the differential diagnosis of liver inflammatory lesions and PHC.Conclusion CEU examination has certain value in differential diagnosis of liver inflammatory lesions and PHC.Quantitative analysis of CEU can objectively display the blood flow perfusion characteristics of liver inflammatory lesions and PHC,thereby elucidating the associated factors for their difference in clearance times.