全氟丁烷超声造影联合CEUS LI-RADS对肝细胞癌的诊断价值

摘要/Abstract

摘要： 目的探讨全氟丁烷超声造影对HCC的诊断性能。方法回顾性分析84例行全氟丁烷超声造影患者的影像资料,观察病灶在血管相及在血管后相(Kupffer相)的表现。参照CEUS LI-RADS 5类标准,出现APHE伴延迟(≥60 s)/轻度廓清;将血管后相低增强代替延迟或轻度廓清,以动脉期高增强(APHE)伴血管后相低增强为诊断标准。以病理结果及影像学随访为最终的金标准。分析两种方法对HCC的诊断效能。结果 84例患者中恶性病灶65个,良性病灶19个。CEUS LR-5类的敏感度、特异度、准确度、阳性预测值、阴性预测值和约登指数分别为76.3%、93.1%、82.1%、95.5%、67.5%和0.695;APHE联合血管后相低增强的敏感度、特异度、准确度、阳性预测值、阴性预测值和约登指数分别为81.8%、93.1%、85.7%、95.7%、73.0%、0.749。APHE联合血管后相敏感度明显提高,差异有统计学意义(χ²=11.58,P<0.05)。两种诊断方法与金标准相比,差异均有统计学意义(P<0.05)。结论以APHE联合血管后相低增强作为HCC诊断标准具有较高的灵敏度,全氟丁烷特有的血管后相可以为HCC的无创诊断提供更多的信息。

关键词: 肝细胞癌, 超声造影, 全氟丁烷, 肝脏影像报告与数据管理系统, 无创诊断

Abstract: Objective To investigate the diagnostic performance and clinical application value of perfluorobutane contrast-enhanced Ultrasound (CEUS) for hepatocellular carcinoma (HCC). Methods The imaging data of high-risk patients with liver cancer who underwent perfluorobutane CEUS from October 2021 to July 2023 were retrospectively analyzed. The enhancement pattern, regression time and degree of the lesions in vascular phase, and the regression of the lesions in Kupffer phase were observed. In this study, HCC was diagnosed by the following two methods: (1) Arterial phase hyperenhancement (APHE) with delayed /mild washout, which was defined by the 5 categories criteria of contrast-enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS); (2) Hypoenhancement in posterior vascular phase was taken the place of delayed or mild washout, and hyperenhancement in arterial phase (APHE) with hypoenhancement in posterior vascular phase was used as the diagnostic criteria. With the pathological results and imaging follow-up as the golden standard. The diagnostic efficacy of the two methods for diagnosing HCC was analyzed. Results There were 65 malignant lesions in 84 patients, including 55 HCC lesions. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Youden index of CEUS LR-5 category for HCC were 76.3%, 93.1%, 82.1%, 95.5%, 67.5% and 0.695, respectively. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Youden index of APHE combined with hypoenhancement of posterior vascular phase were 81.8%, 93.1%, 85.7%, 95.7%, 73.0% and 0.749, respectively. The sensitivity of APHE combined with Kupffer phase was significantly increased (χ²=11.58, P<0.05). Compared with the golden standard, the differences between the two diagnostic methods were statistically significant (P<0.05). Conclusion The combination of high arterial phase enhancement (APHE) and low vascular phase enhancement has a higher sensitivity for the diagnosis of HCC. The unique Kupffer phase of perfluorobutane may improve the detection rate of early HCC and provide more information in non-invasive diagnosis of HCC.

Key words: Hepatocellar carcinoma, Contrast-enhanced Ultrasound, Perfluorotane, LI-RADS, Non-invasive diagnosis

刘婷, 杨金雨, 刘倩玉, 杨青. 全氟丁烷超声造影联合CEUS LI-RADS对肝细胞癌的诊断价值[J]. 肝脏, 2024, 29(4): 391-394.

LIU Ting, YANG Jin-yu, LIU Qian-yu, YANY Qing. The value of perfluorobutane contrast-enhanced ultrasound for the diagnosis of hepatocellular carcinoma[J]. Chinese Hepatolgy, 2024, 29(4): 391-394.

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