超声造影联合CT定量参数鉴别诊断肝脏局灶性结节增生与肝细胞癌的价值研究

摘要/Abstract

摘要： 目的探讨超声造影联合CT定量参数在鉴别诊断肝脏局灶性结节性增生(FNH)与肝细胞癌(HCC)中的价值,为临床诊疗提供参考依据。方法收集2019年8月至2024年9月本院诊治的51例HCC患者和62例FNH患者的临床资料,所有患者均接受CT平扫、灌注增强扫描及超声造影检查。对比两组的CT定量参数[肝血容量、肝血流量、肝动脉灌注量(HAP)、门静脉灌注量(PVP)、总肝灌注量(TLP)、肝动脉灌注指数(HPI)、平均通过时间(mTT)]及超声造影特征[最大强度时间(RT)、从增强开始至最大强度时间(TTP)、平均通过时间(MTT)、峰值强度(PI)],由两名影像科医师独立分析参数差异。采用ROC曲线及约登指数评估诊断效能,采用灵敏度、特异度和AUC值评估联合检测效能。结果 CT定量参数比较中,HCC患者的肝血容量、肝血流量、PVP高于FNH组(P<0.05),而HAP、HPI、mTT低于FNH组(P<0.05)。超声造影中,HCC组RT短于FNH组,而TTP、MTT、PI均长于FNH组(P<0.05)。RT、TTP和MTT在鉴别FNH与HCC中的预测灵敏度分别为74.5%、51.0%和47.1%,特异度分别为62.9%、91.9%和74.2%,AUC分别为0.711、0.743和0.622;PI和肝血容量的预测灵敏度分别为56.9%和58.8%,特异度分别为83.9%和88.7%,AUC分别为0.748和0.757;肝血流量、PVP和HPI的灵敏度分别为76.5%、84.3%和90.2%,特异度分别为87.1%、96.8%和77.4%,AUC分别为0.824、0.949和0.925;mTT的灵敏度和特异度分别为86.3%和72.6%,AUC为0.814。当超声造影与CT定量参数联合预测时,灵敏度和特异度分别达到96.1%和96.8%,AUC为0.979。结论超声造影联合CT定量参数可有效提高FNH与HCC的鉴别诊断能力,其联合应用具有较高的灵敏度、特异度和准确率,临床价值显著。

关键词: 超声造影, CT定量参数, 肝细胞癌, 肝脏局灶性结节性增生, 鉴别诊断

Abstract: Objective To explore the value of contrast-enhanced ultrasound (CEUS) combined with computed tomography (CT) quantitative parameters in differentiating focal nodular hyperplasia (FNH) from hepatocellular carcinoma (HCC), and to provide a reference for clinical diagnosis and treatment. Methods The clinical data of 51 HCC patients and 62 FNH patients diagnosed and treated from August 2021 to September 2024 were collected. All patients underwent non-contrast CT scans, perfusion-enhanced CT scans, and CEUS examinations. CT quantitative parameters [hepatic blood volume, hepatic blood flow, hepatic arterial perfusion (HAP), portal venous perfusion (PVP), total liver perfusion (TLP), hepatic arterial perfusion index (HPI), and mean transit time (mTT)] and CEUS characteristics [time to maximum intensity (RT), time to peak enhancement (TTP), mean transit time (MTT), and peak intensity (PI)] were compared between the two groups. Two radiologists independently analyzed the differences of the parameters. Diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves and Youden′s index. The combined detection efficacy was assessed in terms of sensitivity, specificity, and area under the curve (AUC). Results Hepatic blood volume, hepatic blood flow, and PVP were significantly higher in the HCC group than those in the FNH group (P<0.05), whereas HAP, HPI, and mTT were significantly lower (P<0.05). In CEUS, RT was shorter in the HCC group, whereas TTP, MTT, and PI were longer than those in the FNH group (P<0.05). For differentiating FNH from HCC, the sensitivity of RT, TTP, and MTT was 74.5%, 51.0%, and 47.1%, respectively; their specificity was 62.9%, 91.9%, and 74.2%; and their AUC values were 0.711, 0.743, and 0.622, respectively. The sensitivities of PI and hepatic blood volume was 56.9% and 58.8%, respectively, with specificities of 83.9% and 88.7%, and AUC values of 0.748 and 0.757. The sensitivities of hepatic blood flow,, PVP, and HPI was 76.5%, 84.3%, and 90.2%, respectively, with specificities of 87.1%, 96.8%, and 77.4%, and AUC values of 0.824, 0.949, and 0.925. The sensitivity and specificity of mTT were 86.3% and 72.6%, with an AUC of 0.814. When CEUS and CT quantitative parameters were combined, the sensitivity and specificity reached 96.1% and 96.8%, respectively, with an AUC of 0.979. Conclusion CEUS combined with CT quantitative parameters can effectively improve the diagnostic accuracy in differentiating FNH from HCC. This combined approach demonstrates high sensitivity, specificity, and accuracy, offering significant clinical value.

Key words: Contrast-enhanced ultrasound, Computed tomography quantitative parameters, Focal nodular hyperplasia, hepatocellular carcinoma, Differential diagnosis

李晓艳, 张景芳, 王春萍, 周平安. 超声造影联合CT定量参数鉴别诊断肝脏局灶性结节增生与肝细胞癌的价值研究[J]. 肝脏, 2025, 30(7): 938-942.

LI Xiao-yan, ZHANG Jing-fang, WANG Chun-ping, ZHOU Ping-an. The value of contrast-enhanced ultrasound combined with CT quantitative parameters in differentiating focal nodular hyperplasia from hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(7): 938-942.

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参考文献

[1] 张传辉, 姚冬月, 柳思琪, 等. 晚期肝细胞癌一线治疗新进展[J]. 中华肝脏病杂志,2024,32(2):173-179.
[2] Myers L, Ahn J. Focal nodular hyperplasia and hepatic adenoma: evaluation and management[J]. Clin Liver Dis, 2020, 24(3): 389-403.
[3] 谭玉英, 张鑫, 张娟子, 等. MRI联合血清GPC3水平鉴别肝脏结节性增生病灶临床应用价值研究[J]. 实用肝脏病杂志,2022,25(1):88-91.
[4] 郎也, 马春琼, 邓礼巍, 等. 利用磁共振成像多模态参数鉴别肝胆期高信号的肝细胞癌与局灶性结节增生[J]. 中华肝脏病杂志,2022,30(10):1069-1073.
[5] 隋虎, 毛佳, 陈露, 等. CT定量参数鉴别诊断肝局灶性结节增生与肝细胞癌的价值研究[J]. 实用肝脏病杂志,2024,27(4):611-614.
[6] 王正华, 王明达, 张晓谦. 超声造影诊断肝脏占位性病变良恶性效能分析[J]. 实用肝脏病杂志,2024,27(4):607-610.
[7] Parra N S, Ross H M, Khan A, et al. Advancements in the diagnosis of hepatocellular carcinoma[J]. J Transl Med, 2023, 3(1): 51-65.
[8] Guan M C, Wang M D, Liu S Y, et al. Early diagnosis and therapeutic strategies for hepatocellular carcinoma: from bench to bedside[J]. World J Gastro Oncol, 2021, 13(4): 197-215.
[9] Dong Y, Wang W P, Mao F, et al. Imaging features of fibrolamellar hepatocellular carcinoma with contrast-enhanced ultrasound[J]. UiM/EJU, 2021, 42(03): 306-313.
[10] Subramanian M, Low H M, Kim M J, et al. Benign focal liver lesions masquerading as primary liver cancers on MRI[J]. Diagn Interv Radiol, 2020, 26(3): 168-175.
[11] LeGout J D, Bolan C W, Bowman A W, et al. Focal nodular hyperplasia and focal nodular hyperplasia-like lesions[J]. Radiographics, 2022, 42(4): 1043-1061.
[12] Takeda N, Tsuchiya A, Natsui K, et al. Novel strategy for diagnosis of focal nodular hyperplasia using gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid: enhanced magnetic resonance imaging and magnetic resonance elastography[J]. Case Rep Gastroenter, 2021, 15(2): 507-512.
[13] Kaplan E, Kaplan S. Computed tomographic perfusion imaging for the prediction of response transarterial radioembolization with Yttrium90 glass microspheres of hepatocellular carcinoma[J]. ERMPS, 2021, 25(1): 366-375.
[14] Gadupudi V, Ramachandran R, Mohanarangam V S P. The role of computed tomography perfusion in various focal liver lesions[J]. Cureus, 2022, 14(12): e32420.
[15] Perl R M, Portugall J, Hinterleitner C, et al. Differences between CT-perfusion and biphasic contrast-enhanced CT for detection and characterization of hepatocellular carcinoma: potential explanations for discrepant cases[J]. Anticancer Res, 2021, 41(3): 1451-1458.
[16] Schwarz S, Clevert D A, Ingrisch M, et al. Quantitative analysis of the time-intensity curve of contrast-enhanced ultrasound of the liver: differentiation of benign and malignant liver lesions[J]. Diagnostics, 2021, 11(7): 1244.
[17] Han D, Wang T, Wang R, et al. Application of quantitative parameters of contrast-enhanced ultrasound in common benign and malignant lesions in pediatric livers: a preliminary study[J]. Diagnostics, 2023, 13(22): 3443.
[18] Pan J, Chen W, Zhang H, et al. Contrast-enhanced ultrasonography versus contrast-enhanced magnetic resonance imaging in the diagnosis of mediastinal tumors[J]. Ultrasound Med Biol, 2021, 47(2): 261-271.
[19] Ye Z, Cao L, Wei Y, et al. Preoperative prediction of hepatocellular carcinoma with highly aggressive characteristics using quantitative parameters derived from hepatobiliary phase MR images[J]. ATM, 2020, 8(4): 85.
[20] Shao C C, Zhao F, Yu Y F, et al. Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma[J]. CMJ, 2021, 134(10): 1181-1190.