超声造影对肝硬化背景下早期肝癌与增生结节鉴别诊断

发布时间：2018-03-12 23:24

本文选题：超声造影　切入点：肝硬化　出处：《中国超声医学杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的探讨超声造影(CEUS)对肝硬化背景下早期HCC的诊断效能,通过分析早期HCC增强特征,提高CEUS对早期HCC与增生结节的鉴别诊断能力。方法接受CEUS检查的肝硬化患者2 130例,176例满足入选标准。以超声引导穿刺活检病理诊断作为金标准,通过ROC曲线回顾性分析CEUS对不同直径分层下HCC的诊断效能,并对早期HCC与增生结节的CEUS增强模式进行对比分析。结果 176例患者176个结节中HCC 127个,良性结节49个。85.8%(109/127)HCC结节在CEUS上表现为动脉期高增强,1~2cm组和2~3cm组中的81.0%和90.0%的HCC结节动脉期表现为高增强。1~2cm组和2~3cm组中HCC表现为典型增强模式的结节分别为72.4%和88.4%(P=0.022)。58个1~2cm组HCC,16个结节不符合指南推荐典型HCC的CEUS增强模式。结论 CEUS对肝硬化背景下HCC早期诊断及与各类增生结节的鉴别诊断具有较高的诊断效能;与直径2~3cm的HCC相比,直径1~2cm的HCC表现为典型增强模式的比例降低,应高度警惕;动脉期高增强表现对早期HCC诊断具有重要价值,但应注意与动脉期高增强的增生不良结节进行鉴别。
[Abstract]:Objective to evaluate the diagnostic efficacy of contrast-enhanced ultrasonography (CEUs) for early HCC in cirrhotic patients and to analyze the enhanced features of early HCC. Methods to improve the ability of CEUS in differential diagnosis of early HCC and hyperplastic nodules. Methods 2130 patients with liver cirrhosis underwent CEUS examination and 176 patients met the inclusion criteria. Ultrasound guided biopsy was used as the golden standard. The diagnostic efficacy of CEUS for HCC with different diameters was analyzed retrospectively by ROC curve, and the CEUS enhancement model of early HCC and hyperplastic nodules was compared with that of hyperplastic nodules. Results HCC 127 of 176 nodules were found in 176 patients. On CEUS, 49 cases of benign nodules. 85.8% 10 9 / 127 HCC nodules showed high enhancement in arterial phase in 1cm group and 81.0% and 90.0% in 2cm and 2cm group respectively. The typical enhancement patterns of HCC in 2cm and 22cm groups were 72.4% and 88.40.58, respectively. In the 2cm group, 16 nodules were not in accordance with the typical CEUS enhancement model recommended by the guidelines. Conclusion CEUS has high diagnostic efficacy in the early diagnosis of HCC in cirrhotic background and differential diagnosis with various proliferative nodules. Compared with HCC with diameter of 2 ~ 3 cm, the proportion of HCC with diameter of 1 ~ 2 cm was lower than that of typical enhancement model, and should be highly alert, and the high contrast enhancement of arterial phase was of great value in the diagnosis of early HCC. However, attention should be paid to the differentiation of hyperplastic nodules with high enhancement in arterial phase.
【作者单位】：天津市第三中心医院超声科天津市肝胆疾病研究所天津市人工细胞重点实验室卫生部人工细胞工程技术研究中心;
【基金】：天津市卫生局科技基金资助(No.2013KY03)
【分类号】：R445.1;R575.2;R735.7

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