螺旋CT 诊断混合型肝癌的价值

混合型肝癌(combined hepatocellular carcinoma and cholangio carcinoma ,cHCC-CC)是原发性肝癌中少见病理类型,同时具有肝细胞癌(hepatocellular carcinoma,HCC)和胆管细胞癌(cholangio carcinoma,CC)的成分和特征,临床上称为混合型肝细胞-胆管细胞癌[1-2] .本文收集5 例混合型肝癌的临床及MSCT 资料,并综合文献复习,分析、总结该肿瘤的CT 诊断价值.     

超声造影时间-强度曲线与伽马拟合曲线对肝细胞癌的诊断价值

Objective To investigate the value and the enhanced mode of time-intensity curve(TIC)combined with gamma curve of contrast-enhanced ultrasound in diagnosis of hepatocellular carcinoma.Methods The ultrasonic contrast images of 34 patients with hepatocellular carcinoma by the gamma curve were obtained by the time before,increased branch slope parameter, curve sharpness, gamma modulus, peak time,peak intensity, the average pre-peak intensity, increased branch slope and pre-peak area.Results Compared with the peripheral hepatic parenchyma, the curve of the tumor tissue ascended as well as declined more rapidly, peaked earlier with a more intensive peak value.There were significant differences between the two groups in all the data mentioned-above (P＜0.05 ).Conclusions TIC and gamma fit quantitative analysis can reflect the different perfusion characteristics between hepatocellular carcinoma and normal hepatic parenchyma objectively and accurately,so as to provide the quantitative criterion and basis for the diagnosis and hemodynamic study of the hepatocellular carcinoma.     

超声造影时间-强度曲线与伽马拟合曲线对肝细胞癌的诊断价值

Objective To investigate the value and the enhanced mode of time-intensity curve(TIC)combined with gamma curve of contrast-enhanced ultrasound in diagnosis of hepatocellular carcinoma.Methods The ultrasonic contrast images of 34 patients with hepatocellular carcinoma by the gamma curve were obtained by the time before,increased branch slope parameter, curve sharpness, gamma modulus, peak time,peak intensity, the average pre-peak intensity, increased branch slope and pre-peak area.Results Compared with the peripheral hepatic parenchyma, the curve of the tumor tissue ascended as well as declined more rapidly, peaked earlier with a more intensive peak value.There were significant differences between the two groups in all the data mentioned-above (P＜0.05 ).Conclusions TIC and gamma fit quantitative analysis can reflect the different perfusion characteristics between hepatocellular carcinoma and normal hepatic parenchyma objectively and accurately,so as to provide the quantitative criterion and basis for the diagnosis and hemodynamic study of the hepatocellular carcinoma.     

Gd-EOB-DTPA增强MRI对直径≤1 cm HBV相关小肝癌发生肝内转移风险的预测价值

目的 探究钆塞酸二钠(gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid,Gd-EOB-DTPA)增强MRI对直径≤1 cm小肝癌(small hepatocellular carcinoma,sHCC)早期转移的预测价值.材料与方法 选择无肝内转移且...     

最小表观扩散系数值在评估肝细胞性肝癌侵袭性中的价值

目的 使用最小表观扩散系数值(minimum ADC,ADCmin)评估肝细胞性肝癌(hepatocellular carcinoma,HCC)的侵袭性.材料与方法 回顾性分析2015年1月至2020年10月经病理证实并在术前接受MRI扩散加权成像(diffusion weighted imaging,DWI)检查的8...     

超声造影诊断炎症型肝细胞腺瘤的临床应用

目的:探讨炎症型肝细胞腺瘤(inflammatory hepatocellular adenoma,I-HCA)的超声造影(contrast-enhanced ultrasound,CEUS)特征。方法:回顾性分析2009年4月至2019年11月在复旦大学附属中山医院经病理及免疫组织化学证实的28例I-HCA患者28个...     

微小肝细胞癌超声造影与DCE-MRI的对比研究

目的:比较≤1 cm肝细胞癌(hepatocellular carcinoma,HCC)的超声造影与动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)各时相的表现.方法:分析比较53例经术后病理学检查证实的≤1 cm单发HC...     

磷脂酰肌醇蛋白3与原发性肝细胞癌关系研究进展

原发性肝细胞癌(hepatocellular carcinoma,HCC)发病率和死亡率较高[1],对其早发现、早诊断以及早治疗具有重要意义。HCC无创性诊断目前主要包括影像学检查及血清甲胎蛋白(AFP)定量检测。尽管AFP对判断HCC有较高敏感性,但当     

应用定量扩散加权MRI预测肝细胞癌组织学分级的临床价值

肝细胞癌(hepatocellular carcinoma,HCC)影像学检查在其诊断、随访中具有方便、无创等优势,更易被患者接受[1].增强MRI或弥散加权成像(diffu-sion weighted imaging,DWI)已被用于HCC分级鉴别[2].研究显示,非表观扩散系数(apparent diffu-sio...     

3D-DSA引导下的精准TACE治疗肝细胞癌对患者围术期肝功能的影响

目的:探究3D-DSA引导下的精准经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)对肝细胞癌(hepatocellular carcinoma,HCC)其围术期肝功能的影响.方法:选取2018年9月～2020年9月在本院接受治疗的HCC患者48例,采用随机数...     

Clinical evaluation of serum alpha‐fetoprotein–IgM immune complexes on the diagnosis of primary hepatocellular carcinoma

We evaluated clinical significance of serum alpha‐fetoprotein (AFP)‐IgM immune complexes, in comparison with free AFP, on the diagnosis of primary hepatocellular carcinoma (HCC). Serum levels of AFP‐IgM immune complexes and free AFP were determined by the ELISA method and electrochemiluminescence, respectively, in 103 healthy controls, 74 patients suffering from primary HCC, 27 patients suffering from liver cirrhosis, and 63 patients suffering from chronic hepatitis. The best cut‐off value of AFP‐IgM and free AFP for diagnosis of primary HCC were 300 AU/mL and 10 µg/L respectively, according to the area under the curve (AUC) in this study. The sensitivity of AFP‐IgM and free AFP were 64.9 and 79.7%, and the specificity were 75.6 and 80.3%, respectively, when all cases of primary HCC were analyzed, and the AUC of free AFP was larger than that of AFP‐IgM (0.85 vs. 0.72, Z=3.21). However, in case of primary HCC at early stages (stages I and II) were analyzed, the AUC of AFP‐IgM was larger than that of free AFP (0.91 vs. 0.82, Z=1.73), which demonstrated that the sensitivity of AFP‐IgM and free AFP were 94.4 and 72.2%, and the specificity were 81.9 and 79.9%, respectively. When both AFP‐IgM and free AFP were positive, the specificity of diagnosis of primary HCC was 89.1%, and the efficacy was 79.0%. It is concluded that either sensitivity or specificity of serum level of AFP‐IgM immune complexes was higher than that of free AFP in the diagnosis of primary HCC at early stages. As there was false positive AFP‐IgM existed in the patients suffering from cirrhosis and chronic hepatitis, the combination of free AFP and AFP‐IgM could significantly increase specificity and decrease false negative and/or false positive in the primary HCC at early stages. J. Clin. Lab. Anal. 23:213–218, 2009. © 2009 Wiley‐Liss, Inc.     

Performance of SPINK1 and SPINK1‐based diagnostic model in detection of hepatocellular carcinoma

ObjectivesTo identify the SPINK1 or SPINK1‐based model as a more reliable biomarker for the diagnosis of hepatocellular carcinoma (HCC).MethodsSerum samples and related laboratory parameters were collected from 540 subjects (119 healthy donors, 113 patients with chronic hepatitis B, 122 patients with liver cirrhosis, and 186 patients with HCC). SPINK1 was determined by ELISA assay. Differences in each variable were compared by one‐way ANOVA or Kruskal‐Wallis test. ROC (receiver operating characteristic) curve analysis was conducted to compare the diagnostic efficiency of alpha‐fetoprotein (AFP), SPINK1, and a SPINK1‐based combine model constructed by binary Logistic regression.ResultsIn detecting HCC using the other three groups as control, ROC curve analysis revealed that SPINK1 alone reached AUC of 0.899 (0.866–0.933), with the sensitivity of 0.812 of and specificity of 0.953. The combined model increased the AUC to 0.945 (0.926–0.964) with the sensitivity and specificity of 0.860 and 0.910, respectively. For AFP, significantly lower AUC (p < 0.0001) was shown, which was 0.695 (0.645–0.745) with the sensitivity and specificity of 0.634 and 0.718, respectively. In discriminating HCC from liver disease control, AUC of SPINK1 was 0.863(0.826–0.894), the sensitivity and specificity were 0.823 and 0.906, respectively. For combined model, the AUC, sensitivity, and specificity were 0.915 (0.884–0.940), 0.863, and 0.916, respectively. For detecting early‐stage HCC, SPINK1 and combined model achieved the sensitivity of 0.788 and 0.818, respectively, much higher than AFP of 0.485 (p < 0.05); however, the difference between SPINK1 and combined model was not statistically significant (p = 1).ConclusionWe provided solid evidence for SPINK1 as a robust serological tool for HCC diagnosis.     

Comparing the diagnostic value of serum oligosaccharide chain (G-test) and alpha-fetoprotein for hepatitis B virus-related liver cancer

ObjectivesThe study compared the diagnostic efficiency of serum oligosaccharide chain (G-test) and alpha-fetoprotein (AFP) for hepatitis B-related hepatocellular carcinoma (HCC).MethodsSerum samples from 100 patients (divided into five groups of 20 each, namely the hepatitis, liver cirrhosis, liver cancer, health, and interference groups) who were admitted to the Second Affiliated Hospital of Nanchang University from October 2019 to January 2020 were collected, and the levels of G-test and AFP were determined. The sensitivity and specificity of the two indicators were compared, and the receiver operating characteristic curve of the subjects was drawn to evaluate the diagnostic values of G-test and AFP for HCC.ResultsThe diagnostic ability of G-test (area under the curve [AUC]: 0.88 ± 0.05) was better than that of AFP (AUC: 0.76 ± 0.05). When G-test and AFP were combined for detection, the AUC was larger than that of either indicator. The G-test was superior to AFP in the differential diagnosis of early HCC and cirrhosis. A combination of the two indicators (AUC: 0.769 ± 0.05) significantly improved the diagnostic rate for early HCC, indicating that G-test and AFP complemented each other.ConclusionG-test was better than AFP for screening HCC in patients with chronic hepatitis B and cirrhosis. The combination of the two further improved the diagnostic rate of hepatitis B-related liver cancer. The G-test improves the screening rate of early HCC in patients with cirrhosis. Therefore, these markers are of great clinical significance and can improve the sensitivity of HCC detection and reduce missed diagnosis rates.     

IVIM-DWI鉴别诊断肝细胞癌和肝局灶性结节增生

目的 探讨体素内不相干运动扩散加权成像（IVIM-DWI）鉴别肝细胞癌（HCC）与肝局灶性结节增生（FNH）的价值。方法 对407例临床疑似HCC或FNH的患者行常规上腹部MR平扫、动态增强及IVIM-DWI扫描,60例患者（40例HCC,20例FNH）入组。IVIM采用单、双指数模型获得表观扩散系数（ADC）、慢速表观扩散系数（D）、快速表观扩散系数（D^*）及快速扩散成分所占比例（f）。结果 FNH组的ADC、D、D^*及f值分别为（1.60±0.25）×10^-3mm²/s、（1.12±0.17）×10^-3mm²/s、（44.89±18.23）×10^-3mm²/s和（34.80±9.68）%;HCC组分别为（1.32±0.21）×10^-3mm²/s、（0.82±0.21）×10^-3mm²/s、（49.82±20.11）×10^-3mm²/s和（28.72±13.84）%。2组间的ADC、D值差异有统计学意义（P均<0.001）,而D^*、f值差异无统计学意义（P>0.05）。D值相应ROC曲线下面积为0.90,以0.96×10^-3mm²/s为阈值诊断HCC的敏感度、特异度分别为84.44%、90.02%。结论 IVIM-DWI有助于鉴别诊断HCC和FNH,其中双指数模型计算的D值诊断效能更高。     

Diagnostic and prognostic role of serum glypican 3 in patients with hepatocellular carcinoma

α‐Feto protein (AFP) is the widely used tumor marker in the diagnosis of hepatocellular carcinoma (HCC). The aim of this study was to assess the diagnostic and prognostic validity of a novel marker, serum Glypican‐3 (GPC3) and to compare AFP in patients with HCC. One hundred and twenty‐eight patients (75 patients with HCC, 55 patients with cirrhosis, and 28 healthy controls) were included in this study. Cut‐off value of GPC3 was 3.9 pg/ml. AFP was divided into four subgroups, according to cut‐off values with 13, 20, 100, and 200 ng/ml. Sensitivity, specificity, and positive and negative predictive values of GPC3 and AFP_13, AFP₂₀, AFP₁₀₀, AFP₂₀₀ subgroups and also GPC3+AFP_13, GPC3+AFP₂₀, GPC3+AFP₁₀₀, GPC3+AFP₂₀₀ combinations were compared. Serum GPC3 levels were significantly higher in patients with HCC and cirrhosis compared with control subjects (P<0.05). The median serum GPC3 levels were 3.9 pg/ml in controls, 5.51 pg/ml in patients with cirrhosis, and 5.13 pg/ml in those with HCC. The median serum AFP levels were 1.37 ng/ml in controls, 2.32 ng/ml in cirrhotics, and 50.65 ng/ml in HCC patients. The sensitivity, specificity, and positive and negative predictive values of GPC3 was 61.33, 41.82, 58.97, and 44.43%, respectively. The values for AFP were 68.57, 94.55, 94.12, and 70.27%, respectively. There was no correlation between GPC3 levels and prognostic parameters. GPC3 is not a useful diagnostic and prognostic marker for HCC. J. Clin. Lab. Anal. 25:350–353, 2011. © 2011 Wiley‐Liss, Inc.     

实时剪切波弹性成像鉴别诊断肝泡型包虫病与肝细胞癌

目的探讨实时剪切波弹性成像(SWE)鉴别诊断肝泡型包虫病(HAE)与肝细胞癌(HCC)的价值。方法收集20例HAE(HAE组)及30例HCC(HCC组)患者,术前对病灶进行SWE检查,获取所有病灶的平均杨氏模量值;以病理结果为金标准,评价SWE鉴别诊断HAE与HCC的效能。方法HAE组平均杨氏模量值为(34.57±10.76)kPa,高于HCC组的(21.82±3.51)kPa(P<0.001)。ROC曲线显示,HAE及HCC平均杨氏模量值的诊断界值为27.43 kPa,其敏感度为80.00%、特异度为97.00%,AUC为0.869。结论SWE对于鉴别诊断HAE和HCC具有重要临床应用价值。     

Evaluation of cytokeratin-1 in the diagnosis of hepatocellular carcinoma

BackgroundThis study was undertaken to investigate whether serum cytokeratin-1 (CK1) could complement alpha-fetoprotein (AFP) to improve the diagnosis of hepatocellular carcinoma (HCC).MethodsCK1 was identified using western blot and ELISA in serum samples from 250 Egyptian patients including 150 with HCC, 100 with liver cirrhosis (LC) and 50 healthy controls. Multivariate discriminant analysis (MDA) and ROC curve analyses were used to create a predictive model including CK1 in addition to a panel of routine blood markers.ResultsCK1 was identified at 67 kDa and quantified in sera of HCC patients using western blot and ELISA. MDA selected a score for the prediction of HCC from LC patients based on levels of CK1, albumin and AFP. An area under the ROC curves (AUC) of the score was 0.87. The score showed a sensitivity of 87% vs 39% sensitivity of AFP at cutoff value of 200 IU/ml for prediction HCC. Absolute specificity (100%) was obtained to discriminate HCC from healthy individuals.ConclusionsThis study suggests that the use of a combination of score including CK1, AFP and albumin in clinical practice provides a non invasive and simple test that could increase significantly the sensitivity of HCC diagnosis.     

Diagnostic value of serum glypican-3 alone and in combination with AFP as an aid in the diagnosis of liver cancer

BackgroundRecently, a series of studies have been published to examine the possible diagnostic and prognostic values of glypican-3 (GPC3) in liver cancer with conflicting results observed. Thus, the present study aimed to assess the values of preoperative serum GPC3 alone and in combination with AFP for the diagnosis of liver cancer.MethodsAn enzyme-linked immunoassay was used to quantify serum GPC3 in hepatocellular carcinoma group (HCC, n = 210), intrahepatic cholangiocarcinoma group (ICC, n = 36), combined hepatocellular cholangiocarcinoma group (cHCC-CC, n = 8), metastatic liver cancer group (MLC, n = 10) and normal controls (NC, n = 134).ResultsThe area under the curve (AUC) of GPC3 for HCC versus NC was 0.879, with a sensitivity of 79.52% at an optimal cutoff value of 0.0414 ng/mL; when GPC3 was combined with AFP, the AUC and sensitivity were increased to 0.925 and 88.10%, respectively. In addition, 43 of 68 AFP-negative patients had elevated GPC3 levels. Furthermore, the positive rate of GPC3 was significantly higher than the that of AFP for HCC in early stage.ConclusionsSerum GPC3 was superior to AFP for the diagnosis of early-stage HCC, and may be complementary to AFP for distinguishing HCC from NC.     

Evaluation of texture analysis for the differential diagnosis of focal nodular hyperplasia from hepatocellular adenoma on contrast-enhanced CT images

Purpose

To explore the value of CT texture analysis (CTTA) for differentiation of focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) on contrast-enhanced CT (CECT).

Methods

This is a retrospective, IRB-approved study conducted in a single institution. A search of the medical records between 2008 and 2017 revealed 48 patients with 70 HCA and 50 patients with 62 FNH. All lesions were histologically proven and with available pre-operative CECT imaging. Hepatic arterial phase (HAP) and portal venous phase (PVP) were used for CTTA. Textural features were extracted using a commercially available research software (TexRAD). The differences between textural parameters of FNH and HCA were assessed using the Mann–Whitney U test and the AUROC were calculated. CTTA parameters showing significant difference in rank sum test were used for binary logistic regression analysis. A p value < 0.05 was considered statistically significant.

Results

On HAP images, mean, mpp, and skewness were significantly higher in FNH than in HCA on unfiltered images (p ≤ 0.007); SD, entropy, and mpp on filtered analysis (p ≤ 0.006). On PVP, mean, mpp, and skewness in FNH were significantly different from HCA (p ≤ 0.001) on unfiltered images, while entropy and kurtosis were significantly higher in FNH on filtered images (p ≤ 0.018). The multivariate logistic regression analysis indicated that the mean, mpp, and entropy of medium-level and coarse-level filtered images on HAP were independent predictors for the diagnosis of HCA and a model based on all these parameters showed the largest AUROC (0.824).

Conclusions

Multiple explored CTTA parameters are significantly different between FNH and HCA on CECT.

     

血浆Dickkopf同源物1检测对肝细胞癌的诊断价值

目的 探讨检测血浆Dickkopf同源物1(DKK1)对肝细胞癌(HCC)的诊断价值。方法 选取2014年11月～2015年12月南通市第三人民医院已确诊的HCC患者48例,肝硬化(LC)20例,慢性乙型肝炎(CHB)20例,选择排除其他慢性疾病的健康体检者(HC)20例,采用ELISA方法定量检测血浆中DKK1浓度,同时采用美国雅培i2000微粒子化学发光免疫分析仪检测其AFP。同时比较分析其ROC曲线及相关性。结果 HCC组DKK1水平均显著高于LC组、CHB组和HC组(Z=-4.132～-5.828,P均<0.001)。DKK1对HCC诊断价值的ROC曲线下面积为0.889,95%置信区间为0.831～0.947,DKK1诊断HCC最佳cutoff值为565 ng/L,其诊断灵敏度为93.8%,特异度为70%,AFP的ROC曲线下面积为0.759,95%置信区间为0.667～0.850。DKK1的AUC显著>AFP(Z=2.28,P=0.022)。DKK1和AFP两指标间无相关性(r=0.148,P=0.316),其中有21例AFP<20 μg/L而其DKK1>565 ng/L的诊断临界值。结论 检测血浆中DKK1可以作为AFP诊断HCC的有效补充,尤其是DKK1对AFP阴性HCC患者的早期诊断价值值得关注。