声晕及血管分布对脂肪肝局灶性脂肪缺失与肝脏恶性病变鉴别的价值

Role of acoustic halo sign and vasculature in differential diagnosis between focal fatty sparing and liver malignancies

目的探讨声晕、血供特征的多普勒超声特征对非均匀性脂肪肝局灶性脂肪缺失与类似于局灶性脂肪缺失的肝脏恶性病变的鉴别价值。方法回顾性分析2012年1月至2015年8月期间在我院超声科检查的47例肝脏局灶性恶性病变患者的58个类似于局灶性脂肪缺失肝脏恶性病变病灶和52例脂肪肝患者的52个非典型非均匀性脂肪肝局灶性脂肪缺失的多普勒超声特征。以声晕、内部血供和血流速度为参数评价其在分析非均匀性脂肪肝局灶性脂肪缺失中的敏感性、特异性、准确性、阳性预测值、阴性预测值。结果肝脏恶性病变的声像特征有声晕、较多血管和血流信号较丰富,脉冲多普勒检测有动脉血流,而非均匀性脂肪肝局灶性脂肪缺失很少探及动脉血流,二者静脉分布数都少。区分二者时,以有声晕、有较多血管和探及动脉血流为肝脏恶性病变判断标准,无声晕、有较少血管或无血管、探及不到动脉血流为肝局灶性脂肪缺失(良性病变)判断标准。结果显示,58个肝脏恶性病变病灶中有13个符合良性或良性可能,45个符合恶性或恶性病变可能;52个非典型非均匀性脂肪肝局灶性脂肪缺失中13个符合占位性病变或占位性病变可能,36个符合脂肪肝局灶性脂肪缺失。以有声晕、有较多血管和有动脉血流存在为恶性病变参照标准鉴别恶性与良性(低脂肪灶)病变,则其敏感性为81.69%、特异性为79.03%、准确性为80.45%、阳性预测值为81.69%、阴性预测值为79.03%。结论出现于无恶性病变危险因素的脂肪肝患者肝脏中无声晕及无动脉血流的可疑病变可能是不典型局灶性脂肪缺失或其他病变,为肝癌或转移癌的可能性较小。有无声晕及有无动脉血流对不典型局灶性脂肪缺失与恶性病变鉴别有一定价值。

Objective To explore the value of the acoustic halo sign and blood supply characteristics of Doppler ultrasound in the differential diagnosis between focal fatty sparing and liver malignant lesions. Methods The clincial data of patients with solitary liver malignant lesions and single focal fatty sparing from January 2012 to August 2015 were reviewed. In 47 patients with liver malignant lesions, the Doppler ultrasound features of 58 malignant lesions mimicking focal fatty sparing were analyzed, and compared with 52 focal fatty sparing from 52 patients of single focal fatty sparing.Based on the presence and absence of acoustic halo sign, internal blood vessels, arterial blood flow in malignant lesions and focal fatty sparing(benign lesions), respectively, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were evaluated. Results Liver malignant lesions were characterized with acoustic halo sign, more internal blood vessels and abundant arterial blood flow signals, as well as arterial blood flow in pulse Doppler, while heterogeneous focal fatty sparing(benign lesions) were featured by no acoustic halo sign, less or no internal blood vessels and no arterial blood flow signals. Among the 58 liver malignant lesions in 47 patients, 13 lesions were diagnosed as benign lesions or probably benign lesions, 45 lesions were diagnosed as malignant lesions or probably malignant lesions. Among the 52 atypical heterogeneous focal fatty sparing in 52 patients, 13 lesions were diagnosed as malignant lesions or probably malignant lesions, and 36 lesions were diagnosed as focal fatty sparing. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the presence and absence of halo sign, internal blood vessels and arterial blood flow for differential diagnosis of malignant lesions from focal fatty sparing were 81.69%, 79.03%, 80.45%,81.69%, 79.03%, respectively. Conclusion Liver focal lesion without acoustic halo sign and arterial blood flow in patients with no malignant risk factors may be atypical focal fatty sparing or other lesions, less likely be liver cancer or metastatic carcinoma. The presence of acoustic halo sign and arterial blood flow has a certain value in differentiating focal fatty sparing from liver malignant lesions.