Focal liver lesions in cirrhosis:Role of contrast-enhanced ultrasonography

Contrast-enhanced ultrasound(CEUS)represents a great innovation for the evaluation of focal liver lesions(FLLs).The main advantage of CEUS is the realtime imaging examination and the very low toxicity in patients with renal failure.Liver cirrhosis has been recognized as a major risk factor for the onset of hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC).HCC in liver cirrhosis develops as the last step of a complex that leads to the gradual transformation from regenerative nodule through dysplastic nodule to HCC.In patients with liver cirrhosis,a surveillance program is recommended consisting of ultrasound(US)for detecting small focal lesions.A wide spectrum of benign and malignant lesions other than HCC may be found in the cirrhotic liver and their differentiation is important to avoid errors in staging diseases that may preclude potentially curative therapies.Several published studies have explored the value of CEUS in liver cirrhosis and they have been shown to have excellent diagnostic and prognostic performances for the evaluation of non-invasive and efficient diagnosis of FLLs in patients at high risk for liver malignancies.The purpose of this article is to describe and discuss CEUS imaging findings of FLLs including HCC and ICC,all of which occur in cirrhotic livers with varying prevalence.

Clinical value of contrast-enhanced ultrasonography in the characterization of focal liver lesions:a prospective multicenter trial

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is increasingly accepted in clinical settings for diagnostic imaging of focal liver lesions (FLLs). This study aimed to assess the efficacy of CEUS in the characterization of FLLs in comparison with final diagnosis based on gold standard assessment. METHODS: The study was approved by the local ethics committee and participating patients provided written informed consent. A total of 148 patients with 164 FLLs were studied. Unenhanced ultrasonography (US) and CEUS were performed using fundamental and harmonic imaging, respectively. Contrast enhancement was assessed during the arterial, portal and late vascular phases after intravenous administration of contrast (SonoVue (R), Bracco, Italy). Sensitivity, specificity and diagnostic accuracy of US and CEUS were compared in identifying the lesion as benign, malignant or indeterminate and its actual tumor type. Final diagnosis was established by biopsy (129/164), MR imaging (11/164) or medical history (24/164). RESULTS: When compared to the gold standard, the number of indeterminate diagnoses was reduced from 56.7% (93/164) as assessed by fundamental imaging to 6.1% (10/164) after SonoVue (R) enhanced US examination. Sensitivity and specificity improved from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively (P<0.01). Diagnostic accuracy of CEUS was 88% in contrast to 41% of baseline US. CONCLUSION: SonoVue (R) enhanced US improves the characterization of FLLs and may limit the need for further investigations.

Contrast-enhanced ultrasonography in the evaluation of incidental focal liver lesions: A cost-effectiveness analysis

AIM To determine whether contrast-enhanced ultrasonography(CEUS) as the first-line method is more costeffective in evaluating incidentally discovered focal liver lesions(FLLs) than is computed tomography(CT) and magnetic resonance imaging(MRI). METHODS Between 2010 and 2015, our prospective study enrolled 459 patients with incidentally found FLLs. The biological nature of FLLs was assessed by CEUS in all patients. CT or MRI examinations were added in unclear cases. The sensitivity and specificity of CEUS were calculated. The total costs of CEUS examinations and of the added examinations performed in inconclusive cases were calculated. Afterwards, the theoretical expenses for evaluating incidentally discovered FLLs using CT or MRI as the first-line method were calculated. The resultswere compared. RESULTS The total cost of the diagnostic process using CEUS for all enrolled patients with FLLs was 75884 USD. When the expenses for additional CT and MRI examinations performed in inconclusive cases were added, the total cost was 90540 US dollar(USD). If all patients had been examined by CT or MR as the first-line method, the costs would have been 78897 USD or 384235 USD, respectively. The difference between the cost of CT and CEUS was 3013 USD(4%) and that between MRI and CEUS was 308352 USD(406.3%). We correctly described 97.06% of benign or malignant lesions, with 96.99% sensitivity and 97.09% specificity. Positive predictive value was 94.16% and negative predictive value was 98.52%. In cases with 4 and more lesions, malignancy is significantly more frequent and inconclusive findings significantly less frequent(P < 0.001).CONCLUSION While the costs of CEUS and CT in evaluating FLLs are comparable, CEUS examination is far more costeffective in comparison to MRI.

Contrast enhanced ultrasound in diagnosing liver lesion that spontaneously disappeared:A case report

BACKGROUND Focal liver lesions(FLLs)are abnormal masses that are distinguishable from the surrounding liver parenchyma,solid or cystic and may be benign or malignant.They are usually detected incidentally on abdominal examinations.The classification of FLLs is very important as it directly determines the diagnosis and treatment of patients.CASE SUMMARY A 46-year-old male patient was admitted into the hospital with tarry stool,during the investigation of this issue an incidental FLL was detected.Upon further investigation of this“incidentaloma”computerized tomography and magnetic resonance imaging reached contradictory conclusions.The lesion was then further investigated using contrast-enhanced ultrasound(CEUS)with an initial diagnosis of idiopathic FLL was acquired and observation of the FLL over time need for final diagnosis,however in the follow up the FLL disappeared spontaneously.CONCLUSION CEUSs value for characterization of FLLs is undeniable,especially when other methods produce inconsistent results,is undeniable but with its limitations.Why and how the FLL disappeared is not known,and can be only hypothesized it was a pseudolesion.

Characteristics of common solid liver lesions and recommendations for diagnostic workup

Due to the widespread clinical use of imaging modalities such as ultrasonography,computed tomography and magnetic resonance imaging (MRI),previously unsuspected liver masses are increasingly being found in asymptomatic patients.This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup.Likely diagnoses include hepatocellular carcinoma (the most likely;a solid liver lesion in a cirrhotic liver) and hemangioma (generally presenting as a mass in a non-cirrhotic liver).Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women.In 70% of cases,MRI with gadolinium differentiates between these lesions.Fine needle core biopsy or aspiration,or both,might be required in doubtful cases.If uncertainty persists as to the nature of the lesion,surgical resection is recommended.If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up,histology is required only when the nature of the liver lesion is doubtful.

Value of contrast-enhanced ultrasound in diagnosis of focal liver lesions

Objective:By observing the pattern of the focal liver lesions(FLL) in different phases by real time contrast-enhanced ultrasound(CEUS),compared to enhanced CT,investigate the value of CEUS in diagnosing focal liver lesions. Methods:35 patients with unconfirmed focal liver lesions were studied by contrast agent SonoVue and Technos DU 8 produced by Esaote company. Results:Among the 14 cases of hepatocellular carcinoma(HCC),10 were typical,presented with early artery enhancement and immediate wash-out. The enhancement patterns of 6 livers metastasis were diverse,including peripheral or entire degree enhancement. The wash-out time in malignant tumors was earlier than other focal liver lesions(P < 0.05),appeared as hypoechoic in the portal phase or parenchyma phase. The 6 cases of hemangioma were enhanced centripetally nodular in artery phase and washed out after several minutes. The patterns of different lesions were similar compared to contrast-enhanced CT,without significant statistic differences. Conclusion:The contrast enhanced ultrasound technique can significantly improved the value of diagnosing focal liver lesions.

Computer-aided diagnosis for contrast-enhanced ultrasound in the liver

Computer-aided diagnosis(CAD) has become one of the major research subjects in medical imaging and diagnostic radiology.The basic concept of CAD is to provide computer output as a second opinion to assist radiologists' image interpretations by improving the accuracy and consistency of radiologic diagnosis and also by reducing the image-reading time.To date,research on CAD in ultrasound(US)-based diagnosis has been carried out mostly for breast lesions and has been limited in the fields of gastroenterology and hepatology,with most studies being conducted using B-mode US images.Two CAD schemes with contrast-enhanced US(CEUS) that are used in classifying focal liver lesions(FLLs) as liver metastasis,hemangioma,or three histologically differentiated types of hepatocellular carcinoma(HCC) are introduced in this article:one is based on physicians' subjective pattern classifications(subjective analysis) and the other is a computerized scheme for classification of FLLs(quantitative analysis).Classification accuracies for FLLs for each CAD scheme were 84.8% and 88.5% for metastasis,93.3% and 93.8% for hemangioma,and 98.6% and 86.9% for all HCCs,respectively.In addition,the classification accuracies for histologic differentiation of HCCs were 65.2% and 79.2% for well-differentiated HCCs,41.7% and 50.0% for moderately differentiated HCCs,and 80.0% and 77.8% for poorly differentiated HCCs,respectively.There are a number of issues concerning the clinical application of CAD for CEUS,however,it is likely that CAD for CEUS of the liver will make great progress in the future.

Imaging features and management of focal liver lesions

Notably,the number of incidentally detected focal liver lesions(FLLs)has increa-sed dramatically in recent years due to the increased use of radiological imaging.The diagnosis of FLLs can be made through a well-documented medical history,physical examination,laboratory tests,and appropriate imaging methods.Although benign FLLs are more common than malignant ones in adults,even in patients with primary malignancy,accurate diagnosis of incidental FLLs is of utmost clinical significance.In clinical practice,FLLs are frequently evaluated non-invasively using ultrasound(US),computed tomography(CT),and magnetic resonance imaging(MRI).Although US is a cost-effective and widely used imaging method,its diagnostic specificity and sensitivity for FLL characterization are limited.FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI.MRI is a problem-solving method with high specificity and sensitivity,commonly used for the evaluation of FLLs that cannot be characterized by US or CT.Recent technical advancements in MRI,along with the use of hepatobiliary-specific MRI contrast agents,have significantly improved the success of FLL characterization and reduced unnece-ssary biopsies.The American College of Radiology(ACR)appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients.ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommend-ations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios.The American College of Gastroenterology(ACG)Clinical Guideline offers evidence-based recommend-ations for both the diagnosis and management of FLL.American Association for the Study of Liver Diseases(AASLD)Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma.In this article,FLLs are reviewed with a comprehensive analysis of ACR Appropri-ateness Criteria,ACG Clinical Guideline,AASLD Practice Guidance,and current medical literature from peer-reviewed journals.The article includes a discussion of imaging methods used for the assessment of FLL,current recommended imaging techniques,innovations in liver imaging,contrast agents,imaging features of common nonmetastatic benign and malignant FLL,as well as current management recommendations.

SonoLiver时间强度曲线在肝脏局灶性占位病变超声造影中的应用价值

目的探讨SonoLiver时间强度曲线在肝脏局灶性占位病变超声造影中的应用价值。方法对72例二维超声发现的肝脏占位性病变患者(良性组38例,恶性组34例)行超声造影检查。利用SonoLiver软件分别对两组患者超声造影的动态过程进行分析,得到动态血管模式曲线(DVP)及时间强度曲线,分析两组局灶性病变的动态血流灌注特点,计算出两组局灶性病变的峰值强度(IMAX)、上升时间(RT)、达峰时间(TTP)、上升支斜率、下降支斜率的绝对值,并行统计学分析。结果良、恶性两组间的血流灌注特点不同。时间强度曲线示良性组IMAX为(116.96±42.54)%,明显小于恶性组的(221.79±73.83)%(P<0.01);良性组RT为(46.84±13.07)s,明显长于恶性组的(23.30±8.36)s(P<0.01);良性组TTP为(55.74±12.95)s,明显长于恶性组的(26.42±9.52)s(P<0.01);良性组上升支斜率(2.36±0.91)%/s,明显小于恶性组的(8.36±3.34)%/s(P<0.01);良性组下降支斜率的绝对值为(0.74±0.32)%/s,明显小于恶性组的(2.06±0.97)%/s(P<0.01)。结论利用SonoLiver软件分析的时间强度曲线可以对肝脏局灶性占位性病变进行量化分析,并有较好的临床应用价值。

高频超声造影在浅表肝脏局灶性病变检出及诊断中的临床价值

目的探讨高频超声造影(CEUS)在浅表肝脏局灶性病变(FLLs)检出及诊断中的临床价值。方法选取我院浅表FLLs患者38例,共63个病变,分别使用低频凸阵探头和高频线阵探头对患者进行CEUS检查,比较低频CEUS与高频CEUS在病变可见度评分、检出率和良恶性鉴别诊断中的差异。结果浅表FLLs在高频CEUS下平均可见度评分和检出率分别为(3.62±0.79)分、93.7%(59/63),均显著高于低频CEUS[(2.44±1.04)分、57.1%(36/63)],差异均有统计学意义(均P<0.05)。高频CEUS对最大径≤1 cm FLLs、最大径1~2 cm FLLs和肝转移瘤的检出率均显著高于低频CEUS[96.7%(29/30)vs.46.7%(14/30)、92.6%(25/27)vs.66.7%(18/27)、100%(26/26)vs.57.7%(15/26)],差异均有统计学意义(均P<0.001)。高频CEUS鉴别诊断浅表FLLs良恶性的灵敏度、准确率分别为92.9%、91.7%,均高于低频CEUS(78.6%、77.8%),差异均有统计学意义(均P<0.05)。结论高频CEUS在提高浅表FLLs的检出率和定性诊断方面均有明显优势,具有重要的临床价值。

超声造影诊断肝脏占位性病变良恶性效能分析

目的探讨超声造影(CEUS)诊断肝脏占位性病变良恶性的效能。方法2020年1月~2023年1月收治的97例肝脏占位性病变患者,接受肝穿刺活检及彩色多普勒超声和CEUS检查,采用Tom Tec Sono Liver CAP软件分析CEUS数据,采用受试者工作曲线(ROC)分析超声诊断肝脏占位性病变良恶性的效能。结果经病理学检查,在97肝脏占位性病变患者中,诊断恶性病变41例(胆管细胞癌5例、转移性肝癌10例、肝细胞癌26例)和良性病变56例(局灶性结节性增生29例和炎性假瘤27例);恶性病变动脉期局部血流量为(63.9±12.1)mL/min,显著大于良性病变【(42.7±8.9)mL/min,P<0.05】,延迟期局部血流量为(17.6±2.4)mL/min,显著小于良性病变【(19.0±2.7)mL/min,P<0.05】;恶性病变始峰时间、达峰时间、上升时间和通过时间分别为(11.5±2.1)s、(34.1±6.9)s、(25.8±4.3)s和(110.5±20.7)s,显著短于良性病变【分别为(14.1±2.3)s、(45.9±6.2)s、(37.6±5.8)s和(149.3±24.1)s,P<0.05】,而灌注指数显著大于良性病变【(141.2±20.0)对(89.7±18.9),P<0.05】;二维超声诊断良恶性肝脏局灶性病变的灵敏度为82.9%,特异度为78.4%,准确度为78.4%,阳性预测值为70.8%,阴性预测值为85.7%,而CEUS诊断良恶性肝脏局灶性病变的灵敏度为80.5%,特异度为82.1%,准确度为81.4%,阳性预测值为76.7%,阴性预测值为85.2%。结论CEUS诊断肝脏占位性病变良恶性具有较高的应用价值,可协助临床决策。

Sonazoid超声造影与普美显增强MRI诊断肝细胞肝癌的对比研究

目的对比Sonazoid超声造影与普美显增强MRI对肝细胞肝癌(HCC)的诊断价值。方法选取我院肝脏占位性病变患者43例,共计55个病灶,其中HCC 41个,良性病灶14个。观察HCC与良性病灶的Sonazoid超声造影及普美显增强MRI图像特征,比较二者对HCC的诊断准确率、灵敏度、特异度;采用Kappa检验分析二者的一致性。结果HCC与良性病灶在动脉期、延迟期及血管后期(Kupffer期)的超声造影增强特征比较差异均有统计学意义(均P<0.05),其中HCC动脉期以高增强为主(75.61%),延迟期均呈等或低增强,Kupffer期以低增强为主(85.37%)。HCC与良性病灶在动脉期和肝胆期的增强MRI增强特征比较差异均有统计学意义(均P<0.05),其中HCC动脉期以高信号为主(65.85%),肝胆期以低信号为主(73.17%)。Sonazoid超声造影和普美显增强MRI对HCC的诊断准确率、灵敏度、特异度分别为87.27%、90.24%、78.57%和90.91%、92.68%、85.71%,二者比较差异均无统计学意义。Sonazoid超声造影与普美显增强MRI诊断HCC的一致性好(Kappa=0.908)。结论Sonazoid超声造影对HCC的诊断效能与普美显增强MRI相当。

Endoscopic ultrasonography-emerging applications in hepatology

The inspection of the liver is a valuable part of the upper endoscopic ultrasonography(EUS) studies,regardless of the primary indication for the examination.The detailed images of the liver segments provided by EUS allows the use of this technique in the study of parenchymal liver disease and even in the diagnosis and classification of focal liver lesions.EUS has also emerged as an important tool in understanding the complex collateral circulation in patients with portal hypertension and their clinical and prognostic value.Recently,EUS-guided portal vein catheterization has been performed for direct portal pressure measurement as an alternative method to evaluate portal hemodynamics.In this review,the authors summarize the available evidence regarding the application of EUS to patients with liver diseases and how we can apply it in our current clinical practice.

超声造影、剪切波弹性成像和增强CT检查诊断肝细胞癌价值分析

目的 探讨超声造影(CEUS)、超声剪切波弹性成像(SWE)和增强CT检查诊断肝占位病变性质的价值。方法 2020年6月~2022年6月我院诊治的肝占位性病变患者128例,术前均行CEUS、SWE【检测杨氏模量最大值(Emax)】和CT检查,取手术后组织或穿刺细胞学检查,作出病理学诊断。结果 在本组128例肝占位性病变患者中,病理学检查诊断肝细胞癌(HCC)72例,良性结节56例;两组CEUS检查动脉期、门脉期和延迟期增强程度具有显著性差异(P<0.05),79.2%HCC组呈“快进快出”表现,81.9%动脉期呈高增强,62.5%门脉期呈低增强,79.2%延迟期呈低增强,80.4%良性病变呈“慢进慢出”表现,44.6%动脉期、76.8%门脉期和80.4%延迟期为等增强。CEUS诊断的敏感性为83.3%,特异性为87.5%,准确性为85.2%,阳性预测值为89.6%,阴性预测值为80.3%;HCC组Emax为(42.5±7.1)kPa,显著高于良性组【(36.3±6.5)kPa,t=5.064,P<0.01】。以Emax≥39.6 kPa为诊断恶性病变的截断点,SWE诊断的敏感性为79.2%,特异性为76.8%,准确性为78.9%,阳性预测值为81.4%,阴性预测值为74.1%;两组病灶增强CT检查动脉期、门脉期和延迟期增强程度具有显著性差异(P<0.05),77.8%HCC病灶呈“快进快出”表现,83.3%动脉期呈高增强,59.7%门脉期呈低增强,77.8%延迟期呈低增强。82.1%良性病变呈“慢进慢出”表现,42.9%动脉期、78.6%门脉期和82.1%延迟期均为等增强。CT诊断的敏感性为77.8%,特异性为87.5%,准确性为82.0%,阳性预测值为88.9%,阴性预测值为75.4%。结论 CT和CEUS都是临床诊断HCC的重要手段,开展SWE检查可以在特殊情况下提供更多的诊断证据,值得探讨。

超声造影联合超微血流成像鉴别诊断肝脏局灶性病变的临床价值

目的探讨超声造影(CEUS)联合超微血管成像(SMI)在良恶性肝脏局灶性病变(FLL)鉴别诊断中的临床价值。方法选取我院经病理确诊的105例FLL患者,其中良性56例,恶性49例,均于术前行CEUS和SMI检查,分析CEUS、SMI及两者联合应用诊断良恶性FLL的灵敏度、特异度、准确率、阳性预测值、阳性预测值,分析其与病理结果的一致性;绘制受试者工作特征(ROC)曲线分析CEUS、SMI及两者联合应用鉴别FLL的诊断效能。结果CEUS检查显示,良恶性FFL动脉期、门脉期、延迟期增强表现比较差异均有统计学意义(均P<0.001);SMI检查显示,良恶性FFL血管形态特征比较差异有统计学意义(P<0.001)。CEUS诊断良恶性FLL的灵敏度、特异度、准确率、阳性预测值、阳性预测值分别为79.60%、80.40%、80.00%、78.00%、81.82%,与病理结果的一致性一般(Kappa=0.599,P<0.05);SMI诊断良恶性FLL的灵敏度、特异度、准确率、阳性预测值、阳性预测值分别为65.30%、66.10%、65.71%、62.75%、68.52%,与病理结果的一致性差(Kappa=0.313,P<0.05);两者联合应用诊断良恶性FLL的灵敏度、特异度、准确率、阳性预测值、阳性预测值分别为89.80%、92.90%、90.48%、89.80%、92.90%,与病理结果的一致性好(Kappa=0.809,P<0.001)。CEUS、SMI与两者联合应用的准确率比较差异均有统计学意义(χ^(2)=4.579、18.818,均P<0.05);CEUS与两者联合应用的灵敏度、特异度比较,差异均无统计学意义;SMI与两者联合应用的灵敏度、特异度比较,差异均有统计学意义(χ^(2)=8.440、10.394,均P<0.05)。ROC曲线分析显示,CEUS与SMI联合应用鉴别诊断良恶性FLL的曲线下面积(AUC)为0.913,高于CEUS、SMI单独应用(0.800、0.657),差异均有统计学意义(Z=2.046、2.634,均P<0.05)。结论CEUS联合SMI鉴别诊断良恶性FLL具有较好的临床价值。

超声造影诊断慢性肝病背景下最大径≤3 cm肝细胞肝癌的临床价值

目的探讨超声造影(CEUS)对慢性肝病背景下最大径≤3 cm肝细胞肝癌(HCC)的诊断价值。方法选取我院收治的189例慢性肝病患者(共252个肝脏局灶性病变),均行CEUS检查,观察HCC增强模式,比较最大径>2 cm与≤2 cm HCC增强模式的差异。以组织病理学或临床诊断结果为金标准,计算HCC典型增强模式及其联合不典型增强模式对最大径≤3 cm HCC的诊断准确率、灵敏度、特异度;绘制受试者工作特征曲线评估其诊断效能。结果252个病灶中,HCC 95个(最大径>2 cm 39个,最大径≤2 cm 56个),其他恶性肿瘤24个,良性病灶133个。HCC动脉期、门脉期、延迟期主要表现为高-等-低增强(38.95%,37/95)和高-低-低增强(29.47%,28/95)的典型增强模式,28.42%(27/95)呈不典型增强模式。最大径>2 cm HCC典型增强模式占比高于最大径≤2 cm HCC(82.05%vs.58.93%),不典型增强模式占比低于最大径≤2 cm HCC(12.82%vs.39.27%),差异均有统计学意义(均P<0.05)。典型增强模式对最大径≤3 cm HCC的诊断准确率、灵敏度、特异度分别为84.52%、65.26%、96.18%,曲线下面积为0.807;其联合不典型增强模式的诊断准确率、灵敏度、特异度分别为93.65%、93.68%、93.63%,曲线下面积为0.937;除特异度外,其余诊断效能与典型增强模式比较差异均有统计学意义(均P<0.05)。结论HCC病灶越小CEUS呈不典型增强模式占比越高;联合典型与不典型增强模式有助于提高对慢性肝病背景下最大径≤3 cm HCC的诊断效能,具有较好的临床价值。

灰阶超声影像组学与超声造影鉴别诊断肝脏局灶性病变良恶性的对比研究

目的对比分析灰阶超声影像组学与超声造影对肝脏局灶性病变(FLLs)良恶性的鉴别诊断价值。方法选取我院经手术病理证实的162例FLLs患者,其中恶性86例,良性76例,均行灰阶超声及超声造影检查,比较两者声像图表现的差异。162例FLLs患者随机按照7∶3比例分为训练组113例和验证组49例,比较两组灰阶超声影像组学参数,包括形态学特征、直方图特征、灰度区域大小矩阵特征、Haralick特征、灰度共生矩阵特征、灰度游程矩阵特征,筛选有意义的非冗余特征,选择最优特征子集构建灰阶超声影像组学模型,绘制受试者工作特征曲线分析其鉴别诊断FLLs良恶性的效能。结果恶性病灶超声造影多表现为动脉相病灶呈高增强,门脉相病灶呈低增强,且两者间存在明显分界(67例);良性病灶超声造影均表现为动脉相病灶呈等增强或稍高增强,造影剂从病灶周边缓慢向中心灌注,门脉相及延迟相病灶均呈等增强或高增强,未见明显的造影剂消退现象。训练组和验证组良恶性病灶直方图特征、灰度共生矩阵特征、灰度游程矩阵特征比较差异均有统计学意义(均P<0.05);最终纳入1个直方图特征、1个灰度共生矩阵特征、1个灰阶游程矩阵特征构建灰阶超声影像组学模型,其鉴别诊断训练组和验证组FLLs良恶性的曲线下面积、灵敏度、特异度分别为0.872、83.33%、80.00%和0.812、76.67%、79.24%,均高于超声造影的曲线下面积(0.764),差异均有统计学意义(均P<0.05)。结论灰阶超声影像组学可有效鉴别FLLs的良恶性,其诊断效能高于超声造影,可为临床提供客观依据。

超声造影LI-RADS鉴别诊断最大径≤3 cm肝脏局灶性病变的临床价值

目的 探讨超声造影(CEUS)LI-RADS鉴别诊断最大径≤3 cm肝脏局灶性病变(FLLs)良恶性的临床价值。方法 选取我院收治的FLLs患者82例,均行常规超声及CEUS检查。采用Kappa检验分析CEUS LI-RADS及常规超声诊断结果与病理诊断结果的一致性;绘制受试者工作特征(ROC)曲线分析CEUS LI-RADS及常规超声鉴别FLLs良恶性的诊断效能,并进一步探讨CEUS LI-RADS鉴别不同大小FLLs良恶性的诊断效能。结果 82例FLLs患者经病理确诊为良性病变3例,恶性病变79例。CEUS LI-RADS鉴别诊断FLLs良恶性的准确率为96.34%(79/82);CEUS LI-RADS与病理诊断结果的一致性(Kappa=0.738)高于常规超声与病理诊断结果的一致性(Kappa=0.394),差异有统计学意义(P<0.05)。ROC曲线分析显示,CEUS LI-RADS鉴别诊断FLLs良恶性的AUC(0.821)大于常规超声(0.783),差异有统计学意义(P<0.05)。CEUS LI-RADS鉴别诊断最大径≥2~3 cm、1~2 cm及<1 cm FLLs良恶性的准确率分别为94.74%、91.18%、70.00%,其诊断最大径≥2~3 cm FLLs的准确率高于最大径<1 cm FLLs,差异有统计学意义(P=0.023);CEUS LI-RADS鉴别诊断最大径1~2 cm、≥2~3 cm FLLs良恶性的AUC(0.917、0.972)均大于最大径<1 cm FLLs(0.667),差异均有统计学意义(均P<0.05)。结论 CEUS LI-RADS可有效判断FLLs恶性风险,且其对最大径1~2 cm、≥2~3 cm FLLs良恶性的鉴别诊断价值高于最大径<1 cm FLLs。

超声造影对肝脏局灶性病变的诊断价值

目的评价超声造影对肝脏局灶性病变的诊断与鉴别诊断价值。方法对103个肝脏局灶性病变的常规超声及超声造影特征进行前瞻性研究,采用5分评分法进行良、恶性诊断及ROC曲线分析,比较超声造影前后肝脏局灶性病变的鉴别诊断价值。结果98.2%恶性病灶(56/57)超声造影动脉相表现为弥漫或环状增强,诊断敏感性98.2%,特异性82.6%;延迟相,82.5%(47/57)恶性病灶增强信号廓清,诊断敏感性82.5%,特异性84.8%。良性病灶中17.4%(8/46)动脉相弥漫增强;84.8%(39/46)延迟相持续增强。血管瘤呈向心性增强,诊断敏感性81.8%,特异性100%。局灶性结节性增生动脉相放射状增强,诊断敏感性66.7%,特异性99.0%。根据诊断评分,超声造影诊断肝脏良恶性病变的敏感性为98.2%,特异性为91.3%,高于常规超声诊断;其ROC曲线下面积(0.948)大于常规超声诊断者(0.811,P=0.000)。结论超声造影肝局灶性良恶性病变具有特征性表现,其诊断应用价值高于常规超声。

肝脏局灶性病变的超声造影定量分析

目的探讨超声造影定量分析在肝脏局灶性病变诊断与鉴别诊断中的应用价值。方法对153例肝脏局灶性病变患者(良性组67例,恶性组86例)行超声造影检查。利用SonoLiver软件分别对两组患者超声造影的动态过程进行分析,得到时间-强度曲线及动态血管模式曲线(DVP)。分析两组局灶性病变的动态血流灌注特点,计算出两组局灶性病变的超声造影定量分析参数:峰值强度(IMAX%)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(MTT),同时计算出上升支斜率与1/2下降支斜率,然后进行统计学分析。结果良性组、恶性组间的血流灌注模式不同,定量分析参数亦有差异:良性组与恶性组的IMAX%、RT、TTP与周围肝组织比较差异有统计学意义(P<0.05);良性组与恶性组间的RT[(13.77±8.11)s和(8.95±4.73)s],MTT[(74.79±73.40)s和(40.75±60.91)s]与1/2下降支斜率[(8.62±13.56)和(43.56±81.42)],差异均有统计学意义(P<0.01),IMAX%差异没有统计学意义(P>0.05)。结论超声造影定量分析可以对肝脏局灶性病变的诊断与鉴别诊断提供较客观的依据,具有一定的临床应用价值。