超声造影对少罕见局灶性肝病变的诊断价值

目的探讨超声造影对少罕见局灶性肝病变（FLL）的诊断价值及“快进快出”造影模式对少罕见FLL超声造影的诊断价值。 方法回顾分析2012年1月至2019年8月在华中科技大学同济医学院附属同济医院就诊的FLL患者的超声造影资料,人群发病率＜0.05%的病变纳入本研究少罕见FLL组,共纳入61个少罕见FLL病灶,其中33个病灶经MRI/CT检查。以病理结果为金标准,采用四格表评价超声造影、MRI/CT检查以及两者联合对少罕见FLL良恶性的诊断效能,并采用χ²检验比较不同检查方式之间诊断准确性的差异。 结果61个少罕见FLL中,超声造影正确诊断病灶良恶性的敏感度为51.9%（28/54）、特异度为85.7%（6/7）、阳性预测值为96.6%（28/29）、阴性预测值为18.8%（6/32）、诊断准确性为55.7%（34/61）。33个同期行MRI/CT检查的少罕见FLL,超声造影良恶性诊断的诊断准确性略高于MRI/CT检查（48.5% vs 39.4%）,但差异无统计学意义（P＞0.05）。超声造影+MRI/CT联合对少罕见FLL良恶性诊断的准确性（69.7%）高于单独MRI/CT检查或超声造影,差异均具有统计学意义（χ²=6.111,P=0.013;χ²=3.070,P=0.046）。对于呈现“快进快出”造影模式的少罕见FLL,超声造影诊断符合率为18.8%（6/32）。实际工作中,超声医师结合临床表现与实验室检查后超声诊断原始报告的诊断符合率为56.3%（18/32）,高于单独超声造影诊断,差异具有统计学意义（χ²=9.600,P=0.002）。 结论超声造影对少罕见FLL具有一定诊断价值,与MRI/CT联合应用可提高诊断准确性。对于“快进快出”造影模式的少罕见FLL的诊断,结合临床表现与实验室检查有助于提高诊断符合率。

Value of contrast-enhanced ultrasonography in diagnosis of rare focal liver lesions

ObjectiveTo evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) for rare focal liver diseases (FLLs), and to explore the diagnostic value of the "fast-forward and fast-out" pattern on CEUS in rare FLLs. MethodsA retrospective analysis was performed on the contrast-enhanced ultrasound data of FLL patients at Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 2012 to August 2019 to identify lesions with a population incidence rate of＜0.05%. A total of 66 such rare lesions were identified, 33 of which were examined by MRI/CT. Using the pathological results as the gold standard, a four-fold table was used to evaluate the diagnostic performance of ultrasound angiography, MRI/CT examination, and their combination for rare benign and malignant FLLs, and χ² test was used to compare the difference in diagnostic accuracy between different examination methods. ResultsAmong the 61 rare FLLs, the sensitivity, specificity, positive predictive value, negative prediction value, and accuracy of CEUS for the diagnosis of benign and malignant lesions were 51.9% (28/54), 85.7% (6/7), 96.6% (28/29), 18.8% (6/32), and 55.7% (34/61), respectively. Among the 33 rare FLLs, the diagnostic accuracy of CEUS was slightly higher than that of MRI/CT, but the difference was not statistically significant (48.5% vs 39.4%, P＞0.05). The diagnostic accuracy of CEUS + MRI/CT for rare benign and malignant FLL (69.7%) was significantly higher than that of MRI/CT or CEUS alone (χ²=6.111, P=0.013; χ²=3.070, P=0.046). For the rare FLLs presenting with the "fast forward and fast out" pattern on CEUS, the diagnostic accuracy of CEUS was 18.8% (6/32). In the actual work, after the combination of clinical manifestations and laboratory tests, the diagnostic accuracy was 56.3% (18/32), which was higher than that of CEUS alone (χ²=9.600, P=0.002). ConclusionCEUS has appreciated diagnostic value for rare FLLs, which is comparable to that of MRI/CT. For the diagnosis of rare FLLs that exhibit the "fast-forward and fast-out" pattern on CEUS, it is helpful to improve the diagnostic accuracy by combining with clinical manifestations.