超声造影与多层螺旋CT在肝透明细胞型癌诊断及手术疗效评估中的应用比较

目的观察超声造影（CEUS）与多层螺旋CT扫描（MSCT）在肝透明细胞型癌（PCCCL）诊断及手术疗效评估的应用效果。方法选取2016年2月~2019年3月本院收治的经手术病理确诊的PCCCL患者100例，另选取同期肝脏局灶性结节增生患者42例，分别行CEUS、MSCT肝脏检查，以手术病理结果为金标准，比较CEUS、MSCT对PCCCL患者不同直径病灶、腹腔积液、后腹膜淋巴结肿大、边缘不清的诊断效果；统计CEUS、MSCT检测的灵敏度、特异度、漏诊率、误诊率；术后1年复诊时采用CEUS、MSCT结果对PCCCL患者的手术疗效（肿瘤复发、转移）进行评价。结果MSCT对直径 < 1 cm的病灶、腹腔积液、后腹膜淋巴结肿大、边缘不清检出情况优于CEUS，差异有统计学意义（P < 0.05）；MSCT对PCCCL的诊断的灵敏度、特异度高于CEUS（P < 0.05），误诊率、漏诊率低于CEUS（P < 0.05）；MSCT对PCCCL患者术后肿瘤复发、转移的检出率高于CEUS（P < 0.05）。结论CEUS及MSCT对于PCCCL均有一定的诊断价值，但MSCT对于微小病灶及异常影像学表现的诊断效果更好，灵敏度、特异度更高，对手术疗效的评估效果更优。 

Comparison of the application of CEUS and MSCT in the diagnosis and surgical assessment of primary clear carcinoma cell of the liver

ObjectiveTo observe the application effect of contrast-enhanced ultrasound (CEUS) and multi-slice spiral computed tomography (MSCT) in the diagnosis and surgical assessment of primary clear carcinoma cell of the liver (PCCCL).Methods100 patients with PCCCL admitted in the hospital and 42 patients with focal nodular hyperplasia of the liver from February 2016 to March 2019 were enrolled in this study. CEUS and MSCT were performed respectively.The diagnostic effects of CEUS and MSCT on different diameter lesions, peritoneal effusion, retroperitoneal lymph node enlargement and unclear margin in PCCCL patients were compared with surgical pathological results as the gold standard; Sensitivities, specificities, missed diagnosis rates and misdiagnosis rates of CEUS and MSCT were statistically analyzed. The results of CEUS and MSCT were used to evaluate the surgical efficacy (tumor recurrence and metastasis) of PCCCL patients at 1 year after operation.ResultsMSCT was superior to CEUS in detecting lesions smaller than 1 cm in diameter, hydrops abdominis, posterior peritoneal lymphadenopathy and unclear margins and the difference was statistically significant (P < 0.05). MSCT had higher sensitivity and specificity than CEUS in the diagnosis of PCCCL (P < 0.05), but the misdiagnosis rate and missed diagnosis rate were lower than those of CEUS (P < 0.05). The detection rates of postoperative tumor recurrence and metastasis in patients with PCCCL by MSCT was higher than those by CEUS (P < 0.05).ConclusionBoth CEUS and MSCT can be used for diagnosis of PCCCL, but MSCT is better for diagnosing small lesions and abnormal imaging findings, with higher sensitivity and specificity. Besides, it is better for surgical effect evaluation.