超声造影时间-强度曲线诊断肝硬化患者肝内小结节病灶价值研究*

目的 探讨应用超声造影(CEUS)时间-强度曲线定性诊断肝硬化伴肝小结节病灶的价值。方法 2019年2月～2020年12月我院诊治肝硬化伴有肝内结节患者108例,均接受穿刺或手术组织病理学检查,术前接受CEUS检查,由软件获得时间-强度曲线上峰值强度(PI) 、上升时间(RT)和达峰时间(PT)等参数。参照CEUS时间-强度曲线诊断恶性结节的标准诊断,应用MedCal 15.2软件绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评价CEUS时间-强度曲线诊断肝硬化伴肝小结节病灶的价值。结果 在108例肝硬化伴肝小结节病灶患者,经病理学检查诊断肝细胞癌43例,肝结节性再生性增生65例;恶性结节组织PI、RT和PT分别为(214.5±20.8)%、(17.6±3.2)s和(24.3±4.6)s,与良性结节组织【分别为(117.2±15.7)%、(38.1±6.9)s和(46.8±8.1)s,P<0.05】或病灶旁肝组织【分别为(115.9±16.1)%、(37.6±6.3)s和(47.4±8.4)s,P<0.05】比,差异显著;应用CEUS诊断恶性结节的灵敏度、特异度和准确性分别为72.1%、73.8%和73.1%,而应用CEUS时间-强度曲线诊断则分别提高到了97.7%、87.7%和91.7%。结论 基于CEUS时间-强度曲线参数诊断肝硬化伴肝内小结节病灶的准确率更高,可为临床诊断提供较为可靠的影像学依据。

Contrast-enhanced ultrasound time-intensity curve in assessment of liver nodules in cirrhotic patients

Objective The aim of this study was to explore the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) time-intensity curve in patients with liver cirrhosis (LC) and intrahepatic nodules. Methods A total of 108 patients with LC and intrahepatic nodules were encountered in our hospital between February 2019 and December 2020, and all underwent liver punctures or operation for histopathological diagnosis. All patients with LC received CEUS and the peak intensity (PI), rise time (RT) and peak time (PT) were obtained based on the time-intensity curve of CEUS. The malignant nodules diagnosed by time-intensity curve of CEUS was defined referred to literature. The area under receiver operating characteristic curve (AUC) by MedCal 15.2 software was applied to evaluate the diagnostic efficacy of parameters. Results Out of the 108 patients with LC and intrahepatic nodules, the histopathological examination showed hepatocellular carcinoma in 43 cases, and benign nodules in 65 cases; the PI, RT and PT in malignant foci were(214.5±20.8)%, (17.6±3.2)s and (24.3±4.6)s, significantly different as compared to (117.2±15.7)%,(38.1±6.9)s and (46.8±8.1)s, respectively, P<0.05] in benign nodules or (115.9±16.1)%, (37.6±6.3)s and (47.4±8.4)s, respectively, P<0.05] in adjacent liver tissues; the sensitivity, specificity and accuracy by CEUS in diagnose malignant nodules were 72.1%, 73.8% and 73.1%, all of them were raised to 97.7%, 87.7% and 91.7% by parameters based on the time-intensity curve of CEUS. Conclusion The diagnosing accuracy of time-intensity curve of CEUS in patients with LC and intrahepatic nodules is efficacious, which might help the clinicians make an appropriate decision for patients and improve the outcomes.