超声造影与增强CT对肝硬化背景下肝内小结节样病灶的诊断比较和误诊分析

目的 比较超声造影(CEUS)与增强螺旋CT(CECT)对肝硬化背景下≤3 cm结节样病灶的诊断效能.方法 对74例84个肝硬化合并肝内小结节样病灶患者行CEUS及CECT检查,评估2种检查方法的诊断效能并分析其误诊原因.结果 CEUS对小结节样病灶的敏感性、特异性、准确性分别为88.6%、87.5%、88.1%,CECT对应值分别为79.5%、95.0%、86.9%(P>0.05).2种检查方法均正确诊断68个结节(33个HCC,35个良性结节),CEUS误诊10个(5个HCC,5个良性结节),CECT误诊10个(8个HCC,2个良性结节),漏诊1个,两者均误诊的有5个结节(3个HCC,2个良性结节).结论 CEUS对肝硬化背景下小结节样病灶的定性诊断价值与CECT相似,对于误诊病例,应予注意.

Diagnosis of Small Hepatic Nodules in Patients with Cirrhosis:Comparison between Contrast-enhanced Ultrasound and Contrast-enhanced Helical CT

Objective To compare contrast-enhanced ultrasound(CEUS) with contrast-enhanced helical computed tomography(CECT) in the diagnosis of various small hepatic nodules(≤3 cm) in cirrhotic livers.Methods Seventy four cirrhosis patients with 84 small hepatic nodules(≤3 cm) underwent CEUS and CECT.The diagnostic performance was calculated and reasons of misdiagnosis was analyzed by using histologic results obtained from biopsy or surgery as the gold standard.Results The sensitivity,specificity and accuracy were 88.6%(39/44),87.5%(35/40),88.1%(74/84)in CEUS and 79.5%(35/44)、95.0%(38/40)、86.9%(73/84)in CECT(P>0.05).Sixty-eight nodules (33 HCC and 35 benign nodules) were correctly diagnosed by both modalities.10 nodules including five HCC and five benign nodules were misdiagnosed by CEUS,compared with 10 nodules,including eight HCC and two benign nodules misdiagnosed by CECT.1 HCC was missed by CECT.Five nodules (3 HCC and 2 benign nodules) were misdiagnosed by both.Conclusions The ability of CEUS in the characterization of small hepatic nodules in cirrhotic livers is similar to that of CECT,so attention must be paid to avoid misdiagnosing.