CEUS与CECT诊断肝癌灶大小可靠性的对比研究

发布时间：2018-01-20 10:53

  本文关键词： 肝癌 造影剂 对比增强超声 增强CT　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究主要目的:探讨CEUS(对比增强超声)与CECT(对比增强计算机断层扫描技术)诊断肝癌灶大小的可靠性(直径3.0cm或3.0cm~5.0cm或5.0cm),旨在明确两种影像学检查方法对癌肿病灶大小诊断的准确性,进而为临床治疗方案提供指导性意见。临床资料回顾性研究分析2013年6月至2016年6月我院所收治的外科手术切除标本经病理组织学证实的肝癌患者197例(所有患者病灶均是单发病灶,术前均行CEUS与CECT检查)。其中男性患者104例,女性患者93例,年龄22~70岁,中位年龄为52岁。肿瘤术后大体标本的最大径1.0~8.0cm,平均最大径(4.0±2.2)cm。CEUS与CECT检查的时间差不超过7天,两种影像学检查方法距病理检查的时间均不超过21天,癌肿直径3~5cm 96例(甲组);癌肿直径3.0cm 63例(乙组),直径5.0cm 38例(丙组)。仪器与诊断方法彩色超声诊断仪器Philips iU22多普勒超声诊断仪,探头频率为2.5~5.0 MHz,具有对比脉冲序列(CPS)CEUS成像技术及实时谐波成像技术(MI),或者使用西门子Sequoia Acuson 512多普勒超声诊断仪,凸阵探头,探头频率为1.0-4.0MHz,并具有CPS的CEUS成像技术。超声造影剂采用的是六氟化硫微泡(声若维)。CECT使用的是美国GE公司生产的VCT 64排螺旋计算机断层扫描仪,造影剂选用的是碘克沙醇。1)CEUS:检查方法:患者先行常规彩超腹部检查,确定病灶位置、大小、形态、界限等;然后开始超声造影,取0.9%生理盐水5ml溶解造影剂冻干粉,震荡混匀后用注射器抽取2.4ml,经肘静脉弹丸式方式注入,并用5ml 0.9%氯化钠溶液冲管。注射造影剂的同时,在造影模式条件下启动彩色多普勒超声诊断仪内置计时器及内置录像记录,实时动态观察病灶组织造影全过程(全程持续6min),然后逐帧分析造影图像。造影诊断结果由两名高年资超声医生独立阅片分析,做出病灶性质及大小的诊断,如果诊断结果不一致,则请主任医师共同阅读分析做出诊断。ceus在肝脏中的全过程可分为3个时相:动脉相(0~30s),门脉相(31~120s),延迟相(121~360s)。2)cect:检查前患者禁食禁水8h以上,先行上腹部平扫后,再行增强扫描,造影剂是经肘静脉采用高压注射器注射。cect造影剂是碘克沙醇(威视派克)。增强诊断结果是由两名医生共同分析完成(若两人诊断结果相差较大,则再请主任医师阅读分析并做出诊断)。cect在肝脏中的全过程可分为3个时期:动脉期、门脉期、平衡期。结果1病理组织学确诊的197例肝癌病变组织,其中原发性肝癌182例(肝细胞癌182例),肝内胆管细胞癌3例,继发性肝癌12例。甲组:原发性肝癌95例(肝细胞癌95例),继发性肝癌1例;乙组:原发性肝癌54例(肝细胞癌54例),继发性肝癌9例;丙组:原发性肝癌33例(肝细胞癌33例)胆管细胞癌3例,继发性肝癌2例。1.1基础病史甲组:95例肝细胞癌病灶,合并肝炎病史89例(肝炎肝硬化63例),合并脂肪肝病史5例,1例无任何基础病史;1例继发性肝癌病灶合并慢性萎缩性胃炎病史(病理提示原发灶来源于胃)。乙组:54例原发性肝癌病灶,合并有肝炎病史50例(肝炎肝硬化48例),合并有脂肪肝病史2例,2例无任何基础病史;9例继发性肝癌病灶,(病理提示病理提示5例原发灶来源于胃,4例原发灶来源于结肠);丙组:36例原发性肝癌病灶,合并有肝炎病史33例(肝炎肝硬化31例),3例无任何基础病史;1例15年前行结肠癌根治术后(病理提示原发灶来源于结肠),1例继发性肝癌病灶(病理提示病理提示原发灶来源于胃)。1.2肝癌病灶ceus与cect增强表现及测量本研究中原发性肝细胞癌病灶ceus多呈现“快进快出”表现,即动脉相病灶整体呈球状快速增强,门脉相早期开始廓清(增强与廓清时间明显早于周围肝组织)即“快进快出”;肝内胆管细胞癌及转移性肝癌病灶CEUS呈现“快进更快出”表现,即动脉相病灶呈树枝状快速增强,动脉相开始廓清,时间更快于HCC。原发性肝癌病灶CECT大多数也呈现“快进快出”表现,即动脉期高增强、门脉期等增强、延迟期低增强,少数成像“快进慢出”表现,即动脉期及门脉期高增强,延迟期等增强;转移性肝癌病灶CECT呈现“快进更快退”表现。CEUS与CECT测量病灶大小时,多方位多角度观察后,每位诊断医生均独立分析图像完成后,选取病灶界限清晰,横截面最大的图像作为所测量的病灶最大径(CEUS一般取肿瘤最大面时间段测定肿瘤的大小;CECT一般在静脉相测定肿瘤大小)。2.CEUS与CECT在197例肝癌病灶大小的受试患者工作特征曲线(ROC)下面积分别为0.774、0.706,二者整体差异无统计学意义(P0.05)。3.甲组:CEUS特异度为80.6%-85.8%,敏感度73.2%-91.6%,CECT特异度为65.1%-77.2%,敏感度63.2%-85.3%。CEUS与CECT方法检查诊断准确率分别为97.9%(94/96)和89.6%(86/96),两种检查方法的结果差异具有统计学意义(P0.05);乙组:CEUS与CECT检查方法诊断准确率分别为90.4%(57/63)和87.3%(55/63),两种检查方法的结果差异无统计学意义(P0.05);丙组:CEUS与CECT检查方法诊断准确率分别为94.7%(36/38)和97.3%(37/38),两种检查方法的结果差异无统计学意义(P0.05)。结论CEUS与CECT对肝癌病灶大小的测量均有较大的临床应用价值,但是对于直径3~5cm的病灶CEUS优于CECT,同时CEUS还具有无创、便携、无辐射和重复性好等优点,不仅可用于治疗方案制定,还可对肝癌的大小在治疗前后的对比有重要价值。因此综合患者自身及临床治疗方案的制定等多方面考虑,对于肝癌病灶大小的测量优先选择CEUS检查具有更高的应用价值。
[Abstract]:Objective the purpose of this study is: To investigate CEUS (contrast enhanced ultrasound (CECT) and contrast enhanced computed tomography) reliability diagnosis of HCC tumor size (diameter of 3.0cm or 3.0cm~5.0cm or 5.0cm), aims at two kinds of imaging methods for cancer diagnosis accuracy of lesion size, so as to provide guidance for clinical treatment retrospective analysis of clinical data. Surgery from June 2013 to June 2016 in our hospital were 197 patients with hepatocellular carcinoma by histopathology confirmed cases of resected specimens (all patients were single lesions, underwent CEUS and CECT examination before surgery). 104 cases of male patients, 93 female patients, aged 22~70 years old, median age for 52 years. After the tumor resection specimens of the largest diameter 1.0~8.0cm, average maximum diameter (4 + 2.2) cm.CEUS and CECT examination of the time difference is not more than 7 days, from the pathological examination of two imaging methods Check the time not more than 21 days, the tumor diameter of 3~5cm in 96 cases (Jia Zu); tumor diameter 3.0cm 63 cases (group B), the diameter of 5.0cm in 38 cases (Bing Zu). Instruments and diagnostic methods of color ultrasonic diagnostic instrument Philips iU22 Doppler ultrasound probe frequency of 2.5~5.0 MHz, with contrast pulse sequence (CPS) CEUS imaging and real-time harmonic imaging (MI), or the use of SIEMENS Sequoia Acuson 512 Doppler ultrasound diagnostic apparatus, convex array probe, probe frequency of 1.0-4.0MHz, CEUS and CPS. The imaging technology of ultrasound contrast agent is used six sulfur hexafluoride microbubbles (sound Ruowei) the use of the.CECT is produced by GE company of America VCT 64 slice spiral CT scanner, the contrast agent is iodixanol.1) CEUS: examination: the patients underwent routine ultrasound examination of the abdomen, to determine the location, size, shape, boundary; then contrast-enhanced ultrasound, 0.9% students Physiological saline 5ml contrast agent dissolved freeze-dried powder, mixing with injection syringe after shock 2.4ml through elbow vein bolus injection, and 5ml 0.9% Sodium Chloride Solution tube. The injection of contrast agent at the same time, start the color Doppler ultrasonic diagnostic apparatus and video recording in the built-in timer built-in contrast mode under the condition of dynamic real-time observation of the whole process of lesions tissue contrast (full 6min), and then the frame analysis contrast image. Contrast analysis of diagnosis results by two senior doctors to make independent ultrasound diagnosis, lesion properties and the size, if not the diagnosis results, please make a diagnosis analysis of chief physician to read.Ceus in the liver of the whole process can be divided into the 3 phase: the arterial phase (0~30s), portal vein (31~120s), delayed phase (121~360s).2) cect: patients before the examination of fasting 8h above the first scan of the upper abdomen, and then underwent enhanced scan, contrast agent is 缁忚倶闈欒剦閲囩敤楂樺帇娉ㄥ皠鍣ㄦ敞灏，

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