超声造影技术诊断肝硬化结节癌变风险及微小肝细胞癌的价值

摘要/Abstract

摘要： 目的研究超声造影(CEUS)技术诊断肝硬化结节(CN)癌变风险及微小肝细胞癌(sHCC)的应用价值。方法选取收集2018年2月至2020年2月医院收治的127例肝硬化结节患者作为研究对象,随访记录127例病理结果。以超声引导穿刺病理活检结果为金标准,记录CN、低度增生不良结节(LGDN)、高度增生不良结节(HGDN)及sHCC。比较不同病理阶段患者CEUS特征,分析CEUS判断CN癌变病理类型和sHCC的准确性。结果 127例患者随访8～32个月,平均(16.6±5.4)个月。最后一次穿刺病理结果显示127例患者中,CN者38例,LGDN者32例,HGDN者26例,sHCC者31例。CN、LGDN、HGDN及sHCC组TTP分别为(44.6±13.2)s,(38.4±10.9)s,(30.5±9.0)s及(23.8±8.5)s,P<0.05;MTT分别为(141.0±35.4)s,(130.4±29.8)s,(117.3±30.2)s及(109.5±27.4)s,P<0.05;RT分别为(40.6±11.2)s,(35.4±7.7)s,(31.2±9.3)s及(22.1±8.7)s,P<0.05。CEUS检查显示CN灌注模式(Ⅳ期31例,Ⅴ期5例,Ⅵ期2例,Ⅶ期1例)、LGDN(Ⅴ期4例,Ⅵ期24例,Ⅶ期3例,Ⅷ期1例)、HGDN(Ⅵ期23例,Ⅶ期3例)及sHCC(Ⅰ期24例,Ⅱ期2例,Ⅲ期5例),各病理阶段患者CEUS灌注模式差异有统计学意义(P<0.05)。ROC分析结果显示TTP(AUC=0.642,95%CI=0.526～0.758)、MTT(AUC=0.651,95%CI=0.536～0.766)及RT(AUC=0.716,95%CI=0.606～0.826)对判断sHCC具有一定应用价值(P<0.05)。TTP、MTT及RT联合预测概率判断sHCC的AUC为0.802(SE=0.047,95%CI=0.710～0.895,P<0.05),敏感度为0.935,特异度为0.561。结论 CEUS能有效鉴别CN病理演变过程,CEUS检查有助于sHCC的早期检出。

关键词: 超声造影, 肝硬化结节, 癌变风险, 微小肝细胞癌

Abstract: Objective To investigate the efficacy of contrast-enhanced ultrasound (CEUS) in diagnosing canceration nodules (CN) in cirrhotic liver and small hepatocellular carcinoma (sHCC). Methods One hundred and twenty-seven patients with liver cirrhotic nodules from February 2018 to February 2020 were included as the research objects. In all patients pathological evaluation of the liver nodules achieved by ultrasound-guided biopsy were recorded as the gold standard, including CN, low-grade dysplastic nodules (LGDN), high-grade dysplastic nodules (HGDN) and sHCC. The characteristics of CEUS in different pathological stages were compared. The accuracy of CEUS in judging the pathological type of CN canceration and sHCC were analyzed. Results The 127 patients were followed up for 8 to 32 months with an average period of time of (16.6±5.4) months. The liver biopsy results showed that there were 38 cases of CN, 32 cases of LGDN, 26 cases of HGDN and 31 cases of sHCC among the 127 patients. The time to peak (TTP)of CN, LGDN, HGDN and sHCC groups were (44.6±13.2)s, (38.4±10.9)s, (30.5±9.0)s and (23.8±8.5)s, respectively(P<0.05), the mean transit time (MTT) were (141.0±35.4)s, (130.4±29.8)s, (117.3±30.2)s and (109.5±27.4)s, P<0.05, the rise time (RT) were (40.6±11.2)s, (35.4±7.7)s, (31.2±9.3)s and (22.1±8.7)s, P<0.05. The CEUS examination showed that the CN perfusion mode (31 cases in stage IV, 5 cases in stage V, 2 cases in stage VI and 1 case in stage VII), LGDN (4 cases in stage V, 24 cases in stage VI, 3 cases in stage VII and 1 case in stage VIII), HGDN(23 cases in stage VI and 3 cases in stage VII), sHCC (24 cases in stage 1, 2 cases in stage II and 5 cases in stage III). The difference of CEUS perfusion mode were statistically significant in different pathological stages (P<0.05). The ROC analysis showed that the TTP (AUC=0.642, 95%CI=0.526～0.758), MTT (AUC=0.651, 95%CI=0.536～0.766) and RT (AUC=0.716, 95%CI=0.606～0.826) had certain application value in judging sHCC (P<0.05). The AUC of sHCC was 0.802 of joint prediction probability of TTP, MTT and RT (SE=0.047, 95%CI=0.710～0.895, P<0.05), the sensitivity was 0.935 and the specificity was 0.561. Conclusion The CEUS can effectively identify the pathological process of CN, and the CEUS examination is helpful for the early detection of sHCC.

Key words: Contrast enhanced ultrasound, Cirrhotic nodules, Canceration risk, Small hepatocellular carcinoma

高杰, 王珂, 张娜, 刘晓阁. 超声造影技术诊断肝硬化结节癌变风险及微小肝细胞癌的价值[J]. 肝脏, 2021, 26(10): 1128-1131.

GAO Jie, WANG Ke, ZHANG Na, LIU Xiao-ge. The use of contrast-enhanced ultrasound in diagnosing canceration nodules in cirrhotic liver and small hepatocellular carcinoma[J]. Chinese Hepatolgy, 2021, 26(10): 1128-1131.

参考文献

[1] Carville K S,Maclachlan J,Thursfield V,et al.Hepatocellular carcinoma over three decades in victoria, australia: epidemiology, diagnosis, and trends, 1984-2013. Intern Med J,2018,48:835-844.
[2] Xiachuan Q, Xiang Z, Xuebing L, et al.Predictive value of contrast-enhanced ultrasound for early recurrence of single lesion hepatocellular carcinoma after curative resection. Ultrason Imaging,2019,41:49-58.
[3] 丁建民,周燕,王凤梅,等.超声造影联合普美显磁共振对肝硬化背景下微小肝细胞肝癌的诊断研究.中华超声影像学杂志,2019,28:964-970.
[4] Shin Choi DJ, Kim JH, et al.Characteristics of contrast-enhanced ultrasound in distinguishing small (≤3 cm) hepatocellular carcinoma from intrahepatic cholangiocarcinoma. Medicine,2018,97:12781-12795.
[5] 刘潇,何年安,叶显俊,等.超声造影对肝细胞癌与肝转移癌的鉴别诊断价值分析.实用肝脏病杂志,2020,23:94-97.
[6] 中华医学会肝病学分会.肝硬化诊治指南.中华肝脏病杂志,2019,27:846-865.
[7] Claudon M,Cosgrove D,Albrecht T,et al.Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver-update 2012.Ultrasound Med Biol,2018,29:28-44.
[8] Gatto A,Gaetano AMD,Giuga M,et al.Differentiating hepatocellular carcinoma from dysplastic nodules at gadobenate dimeglumine-enhanced hepatobiliary-phase magnetic resonance imaging. Abdom Imaging,2013,38:736-744.
[9] 虞梅,梅琪,韩莹莹,等.超声造影灌注时相分析在监控肝硬化结节演变和恶变中的临床价值. 中国癌症杂志, 2019,29:709-714.
[10] Zhang W, Chen HJ, Wang ZJ, et al. Dynamic contrast enhanced MR imaging for evaluation of angiogenesis of hepatocellular nodules in liver cirrhosis in N-nitrosodiethylamine induced rat model. Eur Radiol, 2016, 27:1-9.
[11] 潘宇,袁玉玲,张玉红.肝硬化再生结节和原发性及转移性小肝癌超声造影比较.医学影像学杂志,2020,30:79-82.
[12] 韦立新, 杜经丽, 王玉兰,等.高分化肝细胞癌的病理形态学特征及其病理学诊断与鉴别诊断. 中华病理学杂志, 2014, 43:459-462.
[13] Yeh MM, Liu Y, Torbenson M . Steatohepatitic variant of hepatocellular carcinoma in the absence of metabolic syndrome or background steatosis: a clinical, pathological, and genetic study. Hum Pathol, 2015, 46:1769-1775.
[14] 艾竹,梁倩雯,钟桂棉, 等.多模态影像定量参数分析在肝硬化结节癌变早期诊断及鉴别中的价值.放射学实践,2017,32:990-993.
[15] 毛思月,谢传淼.肝硬化结节和早期肝癌的病理基础及MRI诊断和鉴别.放射学实践,2019,34:1285-1288.
[16] 李茂胜, 谢微波. 肝细胞癌和局灶性结节增生CT定量参数差异及临床鉴别意义. 肝脏, 2019,24:907-910.
[17] 庞海宝, 张淋淋, 陈宇,等. 常规超声及超声造影对结节性肝癌及肝局灶性结节性增生的鉴别诊断价值. 癌症进展, 2018,16:68-70.