动态CEUS-TIC定量分析对复发性小肝癌的诊断价值

目的:研究动态超声造影时间-强度曲线（CEUS-TIC）定量分析对复发性小肝癌的诊断价值。方法:选取接受肝癌切除术后的159例复发性小肝癌患者197个病灶，经病理确诊，患者均接受CEUS检查，以病理确诊结果为标准，分析恶性组和良性组CEUS参数以及各时相灌注模式等差异，并采用受试者特征曲线（ROC）分析动态CEUS-TIC定量参数对复发性小肝癌的诊断价值，计算敏感度、特异性和曲线下面积（AUC）。结果:CEUS显示良性病灶84个，恶性病灶113个，CEUS对恶性病灶诊断的准确率为85.61%（113/132）；恶性组始增时间、达峰时间、等增强开始时间以及低增强开始时间显著短于良性组（t=4.929, t=11.231, t=5.400, t=9.652, P<0.05）；两组动脉期不同时相分布比较，差异无统计学意义（Z=0.700, P>0.05），恶性组门脉期高增强或等增强以及延迟期低增强比例显著高于良性组（Z=2.280, Z=2.160, P<0.05）；始增时间、达峰时间、等增强开始时间和低增强开始时间各参数联合诊断的特异度（92.30%）和AUC（0.942）高于各参数单一诊断的特异度（66.20%、75.40%、43.10%、84.60%）和AUC（0.767、0.808、0.710、0.838）。结论:动态CEUS-TIC定量分析对复发性小肝癌具有良好的诊断价值，是一种简单、可行的诊断复发性小肝癌的检查方法。 【关键词】肝癌；动态超声造影；时间-强度曲线；诊断价值

Diagnostic value of dynamic CEUS-TIC quantitative analysis in recurrent small hepatocellular carcinoma

Abstract: Objective To explore the value of dynamic contrast-enhanced ultrasound time-intensity curve (CEUS-TIC) quantitative analysis to diagnose recurrent small hepatocellular carcinoma. Methods A total of 197 lesions in 159 patients with recurrent small hepatocellular carcinoma after hepatectomy were selected and confirmed by pathology. All patients underwent CEUS examination. The pathological diagnostic results were taken as the standards to analyze the differences in CEUS parameters and perfusion patterns in each time phase between malignant group and benign group. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of dynamic CEUS-TIC quantitative parameters in recurrent small hepatocellular carcinoma, and the sensitivity, specificity and area under the curve (AUC) were calculated. Results CEUS showed that there were 84 benign lesions and 113 malignant lesions. The accuracy rate of CEUS in the diagnosis of malignant lesions was 85.61% (113/132). The initial time of enhancement, time to peak, initial time of iso-enhancement and initial time of hypo-enhancement in malignant group were significantly shorter than those in benign group (t=4.929, 11.231, 5.400, 9.652 P<0.05). There was no statistically significant difference in the arterial phase distribution between two groups (Z=0.700, P>0.05), and the proportions of hyper- or iso-enhancement in portal phase and hypo-enhancement in delayed phase in malignant group were significantly higher than those in benign group (Z=2.280, 2.160 P<0.05). The specificity and AUC of the combined diagnosis of initial time of enhancement, time to peak, initial time of iso-enhancement and initial time of hypo-enhancement were 92.30% and 0.942, higher than those of single diagnosis of each parameter which were 66.20%, 75.40%, 43.10%, 84.60%, and 0.767, 0.808, 0.710, 0.838, respectively. Conclusion Dynamic CEUS-TIC quantitative analysis has good diagnostic value in recurrent small hepatocellular carcinoma, and it is a simple and feasible method for diagnosing recurrent small hepatocellular carcinoma.