超声造影联合超声弹性成像对肝细胞癌微血管侵犯的预测价值

摘要/Abstract

摘要： 目的探讨超声造影联合超声弹性成像对肝细胞癌微血管侵犯(MVI)的预测价值。方法回顾性分析2019年5月—2022年3月我院就诊的75例肝细胞癌患者资料,根据术后病理检查,将患者分为非MVI组(n=28)和MVI组(n=47)。术前所有患者均给予超声弹性成像与超声造影检查,对比2组超声弹性成像与超声造影定量参数,分析肝细胞癌发生MVI的影响因素。分析超声造影、超声弹性成像及二者联合对肝细胞癌发生MVI的预测价值。结果 MVI组廓清时间(60.57±19.45)s比非MVI组(83.23±25.74)s短(P<0.05),2组始增时间与达峰时间对比无显著性差异(P>0.05)。2组肿瘤边缘2 cm处硬度(S2)值对比无显著性差异(P>0.05),MVI组肿瘤边缘1 cm处硬度(S1)值(11.89±4.22)kPa、S1/S2index值(13.04±2.76)高于非MVI组(10.06±2.15)kPa、10.28±2.18(P<0.05)。MVI组肿瘤长径、肿瘤多发、天冬氨酸氨基转移酶、甲胎蛋白(AFP)＞400 μg/L占比高于非MVI组(P<0.05),MVI组白蛋白、血小板计数低于非MVI组(P<0.05)。肿瘤长径增加(OR: 2.843, 95%CI: 1.250~6.468)、肿瘤多发(OR: 3.251, 95%CI: 1.429~7.394)、AFP>400 μg/L(OR: 3.999, 95%CI: 1.758~9.097)、廓清时间缩短(OR: 3.504, 95%CI: 1.540~7.972)、S1/S2index值升高(OR: 4.272, 95%CI: 1.878~9.717)为肝细胞癌发生MVI的影响因素(P<0.05)。受试者工作特征曲线(ROC)结果显示,廓清时间、S1/S2index值及二者联合预测肝细胞癌发生MVI的灵敏度分别为82.98%、85.11%、85.11%,特异度分别为82.14%、85.71%、96.43%,曲线下面积(AUC)值分别为0.781、0.843、0.927(P<0.05),且二者联合的AUC值更高(P<0.05)。结论超声造影定量参数廓清时间联合超声弹性成像定量参数S1/S2index值预测肝细胞癌MVI的价值更高。

关键词: 超声造影, 超声弹性成像, 肝细胞癌, 微血管侵犯, 预测价值

Abstract: Objective To investigate the value of contrast-enhanced ultrasound combined with ultrasound elastography in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Methods The data of 75 patients with HCC admitted from May 2019 to March 2022 were retrospectively analyzed. According to the postoperative pathological examination, the patients were divided into a non-MVI group (n=28) and a MVI group (n=47). All patients were given ultrasound elastography and contrast-enhanced ultrasound before surgery. The quantitative parameters of ultrasound elastography and contrast-enhanced ultrasound were compared between the two groups. The factors affecting the occurrence of MVI in HCC, and the value of contrast ultrasound, elastography and their combination in predicting MVI in HCC were analyzed. Results The clearance time of MVI group was shorter than that of non-MVI group [(60.57±19.45) s vs (83.23±25.74) s, P<0.05]. There was no significant difference between the onset time and peak time between these two groups of patients (P>0.05). Although there was no significant difference in the hardness at 2 cm of tumor edge (S2) between two groups (P>0.05), the hardness at 1 cm of tumor margin (S1) in MVI group and S1/S2 index were higher than those in non-MVI group [(11.89±4.22) kPa vs (10.06±2.15) kPa, (13.04±2.76) vs (010.28±2.18), respectively, (P<0.05)]. The average of tumor length diameter, and the level of aspartate aminotransferase, the proportions of patients with multi-focal tumors and alpha-fetoprotein (AFP) > 400 μg/L in MVI group were higher than those in non-MVI group (P<0.05), whereas the level of albumin and platelet counts in MVI group were lower than those in non-MVI group (P<0.05). The increased tumor length (OR: 2.843, 95%CI: 1.250-6.468), with multi-focal tumors (OR: 3.251, 95%CI: 1.429-7.394), AFP>400 μg/L (OR: 3.999, 95%CI: 1.758-9.097), shortened clearance time (OR:3.504, 95%CI: 1.540-7.972) and increased S1/S2index (OR: 4.272, 95%CI: 1.878-9.717) were the influential factors associated with MVI development of HCC (P<0.05). By receiver operating characteristic curve (ROC) analysis, it was shown that the sensitivity of clearance time, S1/S2index value and their combined prediction of MVI in HCC were 82.98%, 85.11% and 85.11%,, and the specificity was 82.14%, 85.71% and 96.43%, respectively. The area under the curve (AUC) values were 0.781, 0.843 and 0.927 (P<0.05), respectively, and the AUC values of the two combined prediction were higher (P<0.05). Conclusion The clearance time of quantitative parameters of CEUS combined with S1/S2 index value of quantitative parameters of ultrasound elastic imaging has higher value in predicting MVI of HCC.

Key words: Contrast-enhanced ultrasound, Ultrasonic elastic imaging, Hepatocellular carcinoma, Microvascular invasion, Predictive value

陈元莉, 曾德锋, 范会文. 超声造影联合超声弹性成像对肝细胞癌微血管侵犯的预测价值[J]. 肝脏, 2024, 29(9): 1035-1039.

CHEN Yuan-li, ZENG De-feng, FAN Hui-wen. The value of contrast-enhanced ultrasound combined with ultrasound elastography in predicting microvascular invasion of hepatocellular carcinoma[J]. Chinese Hepatolgy, 2024, 29(9): 1035-1039.

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