超声造影特征对肝硬化增生结节与小肝癌的诊断价值

摘要/Abstract

摘要： 目的探讨超声造影特征及相关定量参数在肝硬化增生结节与小肝癌鉴别诊断中的应用价值。方法选取2020年1月至2025年12月汉中市中心医院收治的小肝癌患者45例、肝硬化增生结节患者45例。采用超声造影检查,比较两组患者的定性特征(动脉期、门静脉期、延迟期增强水平及增强类型)与定量参数[动脉期、门静脉期、延迟期血容量(RBV)、血流量(RBF)];采用多因素logistic回归分析筛选鉴别两种病变的独立影响因素,绘制受试者工作特征(ROC)曲线,评估各相关指标的诊断效能。结果小肝癌组动脉期增强水平、动脉期RBV、动脉期RBF显著高于肝硬化增生结节组,门静脉期增强水平、延迟期增强水平、门静脉期RBV、延迟期RBV、延迟期增强水平显著低于肝硬化增生结节组(P<0.05)。多因素logistic回归分析显示,门静脉期增强水平、动脉期RBV、门静脉期RBV、延迟期RBV、动脉期RBF是鉴别两种病变的独立影响因素(P<0.05),其中动脉期RBV、动脉期RBF为危险因素,门静脉期增强水平、门静脉期RBV、延迟期RBV为保护因素。ROC曲线分析显示,上述影响因素联合检测的诊断效能均高于各单一指标(P<0.05),其曲线下面积(AUC)为0.970,灵敏度97.8%、特异度91.1%。结论超声造影的定性特征(各时相增强水平)及定量参数(RBV、RBF)可有效鉴别肝硬化增生结节与小肝癌,其中门静脉期增强水平、动脉期RBV、门静脉期RBV、延迟期RBV、动脉期RBF为关键鉴别指标,联合检测可提升诊断准确性,具有重要的临床诊断价值。

关键词: 超声造影, 肝硬化增生结节, 小肝癌, 鉴别诊断, 定量参数, ROC曲线

Abstract: Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) characteristics and quantitative parameters in differentiating dysplastic nodules (DN) of cirrhosis from small hepatocellular carcinoma (SHCC). Methods A retrospective study included 45 SHCC patients and 45 DN patients admitted to Hanzhong Central Hospital between January 2020 and December 2025. All underwent CEUS. Qualitative features (enhancement level and type in arterial, portal, and delayed phases) and quantitative parameters [regional blood volume (RBV), regional blood flow (RBF) in three phases] were compared. Multivariate logistic regression analysis was used to identify independent differentiating factors between DN and SHCC, and receiver operating curve (ROC) analysis was used to validate the diagnostic performance. Results The SHCC group had significantly higher arterial enhancement level, arterial RBV and arterial RBF, and significantly lower portal enhancement level, delayed enhancement level, portal RBV and delayed RBV than the DN group (P<0.05). Multivariate analysis confirmed portal enhancement level, arterial RBV, portal RBV, delayed RBV and arterial RBF as independent factors (P<0.05); arterial RBV and RBF were risk factors, whereas others were protective factors. Combined detection achieved an AUC of 0.970, sensitivity 97.8% and specificity 91.1%, superior to single indicators (P<0.05). Conclusion CEUS qualitative features and quantitative parameters (RBV, RBF) effectively distinguish DN from SHCC. Portal enhancement level, arterial RBV, portal RBV, delayed RBV and arterial RBF are key indicators, and their combined application improves diagnostic accuracy with important clinical value.

Key words: Contrast-enhanced ultrasound, Dysplastic nodule of cirrhosis, Small hepatocellular carcinoma, Differential diagnosis, Quantitative parameter, ROC curve

张炎, 魏汝峰, 张春玲, 杨琳, 肖琰. 超声造影特征对肝硬化增生结节与小肝癌的诊断价值[J]. 肝脏, 2026, 31(8): 1115-1119.

Zhang Yan, Wei Rufeng, Zhang Chunling, Yang Lin, Xiao Yan. The diagnostic value of contrast-enhanced ultrasound features in dysplastic nodules of cirrhosis and small hepatocellular carcinoma[J]. Chinese Hepatolgy, 2026, 31(8): 1115-1119.

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