超声造影联合MSCT诊断肝硬化合并小肝癌的价值

doi:10.3760/cma.j.issn.1007-1245.2024.23.017

摘要/Abstract

摘要：

目的　分析超声造影（contrast-enhanced ultrasound，CEUS）联合多层螺旋CT（multi-slice spiral CT，MSCT）诊断肝硬化合并小肝癌的价值。方法　回顾性分析2021年10月至2023年10月西安市新城区中医医院收治的97例肝硬化合并局灶性病灶患者的临床资料，根据病理结果分为观察组52例（肝硬化合并小肝癌）与对照组45例（肝硬化增生结节）。观察组男30例，女22例，年龄（45.87±6.74）岁，病灶大小（1.95±0.37）cm；Child肝功能分级：A级43例，B级9例。对照组男27例，女18例，年龄（46.91±7.62），病灶大小（1.89±0.35）cm；Child肝功能分级：A级40例，B级5例。所有患者均接受CEUS、MSCT检查。以病理检查为金标准，分析CEUS、MSCT及二者联合与金标准诊断肝硬化合并小肝癌的一致性。比较两组CEUS参数、MSCT参数，分析CEUS、MSCT及二者联合对肝硬化合并小肝癌的诊断价值。采用t检验、χ²检验进行统计分析。结果　CEUS与金标准诊断肝硬化合并小肝癌的一致性一般（Kappa值=0.628，P<0.05）。CEUS联合MSCT与金标准诊断肝硬化合并小肝癌的一致性较好（Kappa值=0.855，P<0.05）。观察组延迟期、门静脉期局部血容量（regional blood volume，RBV）低于对照组［（472.68±49.83）ml比（745.21±78.16）ml、（1 257.61±138.94）ml比（1 485.79±186.27）ml，均P<0.05］；观察组动脉期局部血流量（regional blood flower，RBF）、RBV高于对照组［（65.96±7.67）ml比（46.12±4.83）ml、（3 472.97±458.21）ml比（1 526.58±272.30）ml，均P<0.05］；两组延迟期、门脉期RBF比较，差异均无统计学意义（均P>0.05）。观察组峰值强度（peak intensity，PI）高于对照组（64.81±7.62比53.20±5.45，P<0.05）；观察组达峰时间（time to peak，TTP）、开始增强时间（arrival time，AT）短于对照组［（28.19±4.65）s比（63.41±7.93）s、（14.26±4.82）s比（19.78±5.84）s，均P<0.05］。两组延迟期、平扫期CT值比较，差异均无统计学意义（均P>0.05）；观察组门静脉期CT值低于对照组（62.45±6.74比83.21±8.95，P<0.05）；观察组动脉期CT值高于对照组（108.49±11.92比65.38±7.21，P<0.05）。CEUS、MSCT及二者联合诊断肝硬化合并小肝癌的曲线下面积（AUC）分别为0.815、0.845、0.928，且二者联合的AUC更高（P<0.05）。结论　CEUS、MSCT诊断肝硬化合并小肝癌具有一定价值，且二者联合具有更高的诊断价值。

关键词:

超声造影, 多层螺旋CT, 肝硬化, 小肝癌, 诊断价值

Abstract:

Objective　To evaluate the value of contrast-enhanced ultrasound (CEUS) combined with multi-slice spiral CT (MSCT) in the diagnosis of cirrhosis complicated with small liver cancer. Methods　The clinical data of 97 patients with cirrhosis and focal lesions treated at Xincheng District Hospital of Traditional Chinese Medicine from October 2021 to October 2023 were retrospectively analyzed. According to the pathological results, they were divided into an observation group (52 patients with cirrhosis and small liver cancer) and a control group (45 patients with cirrhosis hyperplasia nodules). In the observation group, there were 30 males and 22 females; they were (45.87±6.74) years old; their lesion size was (1.95±0.37) cm; Child liver function classification: 43 cases were grade A, and 9 cases were grade B. In the control group, there were 27 males and 18 females; they were (46.91±7.62) years old; their lesion size was (1.89±0.35) cm; Child liver function classification: 40 cases were grade A, and 5 cases were grade B. All the patients underwent CEUS examination and MSCT examination. Pathological examination was used as the gold standard to analyze the consistency of CEUS, MSCT, and their combination with the gold standard in the diagnosis of cirrhosis complicated with small liver cancer. The diagnostic values of CEUS, MSCT, and the combination of CEUS and MSCT for diagnosing cirrhosis complicated with small liver cancer were analyzed. t test and χ² test were used for the statistical analysis. Results　CEUS was consistent with the gold standard in the diagnosis of cirrhosis complicated with small liver cancer in some degree (Kappa=0.628; P<0.05). CEUS combined with MSCT was consistent with gold standard in the diagnosis of cirrhosis complicated with small liver cancer (Kappa=0.855; P<0.05). The regional blood volumes (RBV) in the delayed stage and portal vein stage in the observation group were lower than those in the control group [(472.68±49.83)ml vs. (745.21±78.16) ml and (1 257.61±138.94)ml vs. (1 485.79±186.27)ml; both P<0.05]. The arterial regional blood flower (RBF) and RBV in the arterial stage in the observation group were higher than those in the control group [(65.96±7.67)ml vs. (46.12±4.83)ml and (3 472.97±458.21)ml vs. (1 526.58±272.30)ml; both P<0.05]; there were no statistical differences in RBF in the delay stage and portal vein stage between the two groups (both P>0.05). The peak intensity (PI) in the observation group was higher than that in the control group (64.81±7.62 vs. 53.20±5.45; P<0.05); the time to peak (TTP) and arrival time (AT) in the observation group were shorter than those in the control group [(28.19±4.65) s vs. (63.41±7.93) s and (14.26±4.82) s vs. (19.78±5.84) s; both P<0.05]. There were no statistical differences in the CT values in the delayed stage and plain scan stage between the two groups (both P>0.05). The CT value in the portal vein stage in the observation group was lower than that in the control group (62.45±6.74 vs. 83.21±8.95; P<0.05). The CT value in the arterial stage in the observation group was higher than that in the control group (108.49±11.92 vs. 65.38±7.21; P<0.05). The areas under the curves (AUC) of CEUS, MSCT, and their combination in the diagnosis of cirrhosis complicated with small liver cancer were 0.815, 0.845, and 0.928, respectively; the AUC of their combination was higher (P<0.05). Conclusion　CEUS and MSCT have some value in the diagnosis of cirrhosis complicated with small liver cancer, and their combination has higher diagnostic value.

Key words:

Contrast-enhanced ultrasound, , Multi-slice spiral CT, , Liver cirrhosis, , Small liver cancer, , Diagnostic value

麻红娟张天赐钟玉琴.

超声造影联合MSCT诊断肝硬化合并小肝癌的价值 [J]. 国际医药卫生导报, 2024, 30(23): 3967-3972.

Ma Hongjuan, Zhang Tianci, Zhong Yuqin.

Value of contrast-enhanced ultrasound combined with MSCT in diagnosis of liver cirrhosis complicated with small liver cancer [J]. International Medicine and Health Guidance News, 2024, 30(23): 3967-3972.

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