常规超声和超声造影对肝泡状棘球蚴病和肝内胆管细胞癌的鉴别诊断

摘要/Abstract

摘要： 目的分析常规超声、超声造影(CEUS)对肝泡状棘球蚴病(HAE)、肝内胆管细胞癌(ICC)的鉴别诊断。方法回顾2017年1月—2021年6月收治HAE 42例(男31例、女11例),年龄(55.7±12.2)岁。选取同期ICC患者56例(男37例、女19例),年龄(38.8±14.0)岁。比较HAE、ICC常规超声、CEUS表现,绘制ROC曲线,计算常规超声、CEUS及联合诊断HAE、ICC时AUC值、敏感度及特异度。结果 HAE患者右叶、左叶34例(80.9%)、8例(19.1%),ICC患者右叶、左叶30例(53.6%)、26例(46.4%),差异具有统计学意义(χ²=7.941,P<0.05);HAE患者高、混合及低回声7例(16.7%)、29例(69.0%)及6例(14.3%),ICC患者高、混合及低回声6例(10.7%)、18例(32.1%)及32例(57.1%),差异具有统计学意义(χ²=18.825,P<0.05);HAE、ICC患者胆管扩张为2例(4.8%)、16例(28.6%),差异具有统计学意义(χ²=-9.074,P<0.05);HAE、ICC患者假性囊肿为9例(21.4%)、1例(1.8%),差异具有统计学意义(χ²=10.106,P<0.05);HAE、ICC患者钙化为20例(47.6%)、0例(0),差异具有统计学意义(χ²=33.504,P<0.05)。HAE患者动脉期高、等及低回声27例(64.3%)、7例(16.7%)及8例(19.0%),ICC患者动脉期高、等及低回声46例(82.1%)、8例(14.3%)及2例(3.6%),差异具有统计学意义(χ²=-6.750,P<0.05);HAE患者环状、不均匀、离心性及向心性增强36例(85.7%)、4例(9.5%)、2例(4.8%)及1例(2.4%),ICC患者环状、不均匀、离心性及向心性增强6例(10.7%)、26例(46.4%)、13例(23.2%)及11例(19.6%),差异具有统计学意义(χ²=53.172,P<0.05);HAE患者静脉期高、等及低回声1例(2.4%)、13例(30.9%)及28例(66.7%),ICC患者静脉期高、等及低回声0例(0)、1例(1.8%)及55例(98.2%),差异具有统计学意义(χ²=18.445,P<0.05);HAE患者延迟期高、等及低回声1例(2.4%)、11例(26.2%)及30例(71.4%),ICC患者延迟期高、等及低回声0例(0)、2例(3.6%)及54例(96.4%),差异具有统计学意义(χ²=12.340,P<0.05);HAE患者峰值时间、快进快出为(192.7±46.2)s、10例(23.8%),与ICC患者[(32.5±9.2)s、41例(73.2%)]比,差异具有统计学意义(P<0.05)。常规超声、CEUS联合诊断HAE时AUC值均分别显著高于常规超声、CEUS(t=40.018, -14.125, P<0.05)。结论基于常规超声和CEUS的典型特征,可以准确区分HAE和ICC。

关键词: 肝泡状棘球蚴病, 肝内胆管细胞癌, 超声造影

Abstract: Objective To analyze the differential diagnosis of hepatic alveolar echinococcosis (HAE) and intrahepatic cholangiocarcinoma (ICC) by conventional ultrasound (CU) and contrast-enhanced ultrasound (CEUS). Methods From January 2017 to June 2021, 42 cases of HAE (31 males and 11 females, average age 55.7±12.2 years), and fifty-six ICC patients (37 males and 19 females, average age 38.8±14.0 years) were enrolled in this study. The performance of CU and CEUS and their combination in the diagnosis of HAE and ICC were compared by drawing receiver operating characteristic (ROC) curve and calculating the area Under the Curve (AUC). Results There were 34 cases (80.9%) and 8 cases (19.1%) of HAE, and 30 cases (53.6%) and 26 cases (46.4%) of ICC were found in the right lobe and left lobe of the livers, respectively, with statistical significant difference (χ²=7.941, P<0.05). 7 cases (16.7%), 29 cases (69.0%) and 6 cases (14.3%) of HAE patients, and 6 cases (10.7%), 18 cases (32.1%) and 32 cases (57.1%) of ICC patients were shown high, mixed and low echo lesions, respectively, the difference was statistically significant (χ²=18.825, P<0.05). Biliary dilatation was found in 2 cases (4.8%) of HAE and 16 cases (28.6%) of ICC patients, with statistical significance (P<0.05). There were 9 cases (21.4%) and 1 case (1.8%) of pseudo-cyst (χ²=10.106), and 20 cases (47.6%) and 0 cases (0) with calcification (χ²=33.504) in the HAE and ICC patients, respectively, the difference was all statistically significant (P<0.05). There were 27 cases (64.3%), 7 cases (16.7%) and 8 cases (19.0%) in HAE patients, and 46 cases (82.1%), 8 cases (14.3%) and 2 cases (3.6%) in ICC patients with high, equal and low echoic arterial phase, respectively, with statistically significant difference (χ²=-6.750, P<0.05). 36 cases (85.7%), 4 cases (9.5%), 2 cases (4.8%) and 1 case (2.4%) of HAE, and 6 cases (10.7%), 26 cases (46.4%), 13 cases (23.2%),and 11 cases (19.6%) of ICC patients had annular, heterogeneous, eccentric and centripetal enhancement, respectively, with statistically significant difference (χ²=53.172, P<0.05). There were 1 case (2.4%), 13 cases(30.9%)and 28 cases(66.7%)of HAE, and 0 cases (0), 1 case (1.8%) and 55 cases (98.2%) of ICC patients with high, equal and low echoic venous phase, respectively, the difference was statistically significant (χ²=18.445, P<0.05). 1 case (2.4%), 11 cases (26.2%) and 30 cases (71.4%) of HAE patients, and 0 cases (0), 2 cases (3.6%) and 54 cases (96.4%) of ICC patients with high, equal and low echoic delay, respectively, the difference was statistically significant (χ²=12.340, P<0.05). The peak time, fast-forward and fast-out of HAE patients were (192.7±46.2) s and 10 cases (23.8%), which was significantly different from those of (32.5±9.2)s and 41 cases (73.2%) in ICC patients (t=40.018, -14.125, P<0.05). The AUC value of diagnosing HAE by a combination of CU and CEUS was significantly higher than those by CU and CEUS alone (P< 0.05). Conclusion HAE and ICC can be accurately distinguished based on their typical characteristics of CU and CEUS.

Key words: Hepatic alveolar echinococcosis, Intrahepatic cholangiocarcinoma, conventional ultrasound, Contrast-enhanced ultrasound

瓦增成, 杜婷, 许惠晴, 乔志忠. 常规超声和超声造影对肝泡状棘球蚴病和肝内胆管细胞癌的鉴别诊断[J]. 肝脏, 2022, 27(5): 547-549.

WA Zeng-cheng, DU Ting, XU Hui-qing, QIAO Zhi-zhong. The differential diagnosis of hepatic alveolar echinococcosis with intrahepatic cholangiocarcinoma by conventional and contrast-enhanced ultrasound[J]. Chinese Hepatolgy, 2022, 27(5): 547-549.

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