肝脏实性小结节超声造影表现特征及其诊断价值研究

摘要/Abstract

摘要： 目的分析肝脏实性结节直径≤2 cm患者的CEUS表现特征及诊断价值。方法 2018年6月至2020年12月成都医学院第一附属医院收治的肝脏实性结节直径≤2 cm患者140例,分别使用常规超声与CEUS进行检查。结果病理检查显示156个病灶中,良性病变87个,其中血管瘤28个,再生结节42个,脂肪变性5个,炎性坏死10个,汗腺瘤2个;恶性病变69个,不典型增生20个,小肝癌49个,其中肝细胞肝癌中高分化23个,中分化15个,低分化6个,透明细胞癌2个,胆管囊腺癌1个,原发性肝脏大细胞神经内分泌癌2个。以病理学检查为金标准,常规超声诊断良性78例,恶性78例。CEUS诊断良性85例,恶性71例;常规超声诊断的Kappa值、正确、敏感性、特异性、阳性预测值、阴性预测值分别为0.527、76.3%、73.6%、79.7%、85.0%、70.5%,而CEUS分别为0.896、94.9%、94.3%、95.7%、96.5%、93.0%。超声检查结果显示表现极低～低回声42个,中～高回声76个,混合回声38个。156个病灶中有36个表现为动脉期快速增强,门脉快速退出呈“快进快出”,38个至延迟期未见退出呈“快进不出”,5个至延迟期退出呈“快进慢出”,27个呈“慢进不出”,1个动脉期等增强后门脉或延迟期退出呈“等增强-退出”,34个动脉期、门脉期及延迟期呈“等增强”,16个动脉期、门脉期及延迟期呈“无增强”。良性病灶CEUS的始增时间为(14.5±2.9)s,长于恶性病灶的(11.2±2.8)s,达峰时间为(22.9±6.7)s,长于恶性病灶的(20.6±6.2)s,峰值减半时间(169.4±42.6)s,长于恶性病灶的(66.9±30.4)s,均P<0.05。结论 CEUS可实时动态监控肝组织微循环灌注情况,利于观察实质组织微血管结构,有助于病灶性质的判断,其优势可较好的弥补常规超声的不足,有效提高诊断准确率。

关键词: 实性结节, CEUS, 诊断, 常规超声, 小肝癌

Abstract: Objective To analyze the features and diagnostic value of contrast-enhanced ultrasound in patients with solid liver nodules ≤ 2 cm. Methods 140 patients with solid liver nodules ≤ 2 cm in diameter treated in the hospital were enrolled between June 2018 and December 2020. Conventional ultrasound and contrast-enhanced ultrasound were performed on patients. Results Among 156 lesions, pathological examination showed there were 87 benign lesions, including 28 hemangiomas, 42 regenerative nodules, 5 steatosis, 10 inflammatory necrosis and 2 spiroma. And there were 69 malignant lesions of 20 atypical hyperplasias and 49 small hepatocellular carcinomas (SHCC). Among the hepatocellular carcinomas, there were 23 lesions of high differentiation, 15 moderate differentiation, 6 poor differentiation, 2 clear cell carcinomas, 1 bile duct cystadenocarcinoma, and 2 primary hepatic large cell neuroendocrine carcinomas. With pathological examination as the gold standard, 78 benign cases and 78 malignant cases were diagnosed by conventional ultrasound, and 85 benign cases and 71 malignant cases were diagnosed by contrast-enhanced ultrasound. The Kappa value, correctness, sensitivity, specificity, positive predictive value and negative predictive value were 0.527, 76.3%, 73.6%, 79.7%, 85.0%, and 70.5% of conventional ultrasound diagnosis, and were 0.896, 94.9%, 94.3%, 95.7%, 96.5%, and 93.0% of contrast-enhanced ultrasound. Ultrasound examination results displayed 42 lesions of very low to low echoes, 76 of medium to high echoes and 38 of mixed echoes. Among the 156 lesions, 36 lesions showed rapid enhancement in the arterial phase and fast in and fast out in the portal vein phase, 38 showed fast in but no out until the delayed phase, and 5 showed fast in and slow out until the delayed phase, 27 showed slow in but no out, 1 showed equal enhancement-out in portal vein phase or delayed phase after equal enhancement in the arterial phase, 34 showed equal enhancement in arterial phase, portal vein phase and delayed phase, 16 lesions showed no enhancement in the arterial phase, portal vein phase and delayed phase. The initial increase time of contrast-enhanced ultrasound for benign lesions was (14.5±2.9) s, which was significantly longer than [(11.2±2.8) s, P<0.05] for malignant lesions, and the peak time with (22.9±6.7) s was significantly longer than [(20.6±6.2) s, P<0.05] of malignant lesions, and half time of descent with (169.4±42.6) s was significantly longer than [(66.9±30.4) s, P<0.05] of malignant lesions. Conclusion Contrast-enhanced ultrasound can dynamically monitor the liver tissue microcirculation perfusion in real time, facilitate the observation of the microvascular structure of parenchymal tissues, and help judge the nature of the lesion. Its advantages can better make up for the deficiencies of conventional ultrasound and effectively improve the diagnostic accuracy rate.

Key words: Solid nodules, Contrast-enhanced ultrasound, Diagnosis, Conventional ultrasound, Small hepatocellular carcinoma

周成香, 赵林, 苏红, 林海燕, 马俪文. 肝脏实性小结节超声造影表现特征及其诊断价值研究[J]. 肝脏, 2022, 27(5): 543-546.

ZHOU Cheng-xiang, ZHAO Lin, SU Hong, LIN Hai-yan, MA Li-wen. Features and diagnostic value of contrast-enhanced ultrasound in patients with solid liver nodules ≤2 cm[J]. Chinese Hepatolgy, 2022, 27(5): 543-546.

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