原发性肝癌常规超声漏诊原因分析

目的分析常规超声漏诊原发性肝癌的原因。方法回顾性分析我院344例患者464个原发性肝癌病灶的影像学资料。所有病灶均符合临床肝癌诊断标准并同时进行常规超声及CT或MRI检查,且两种影像学手段检查均提示病灶为原发性肝癌。以CT或MRI提示的病灶大小、位置为参考标准,在常规超声声像图上判定病灶是否可检出。比较检出病灶和漏诊病灶大小、部位、肝实质背景差异。结果常规超声检出病灶332个,检出率为71.6%(332/464),病灶最大径为8～198mm,平均(48.9±40.3)mm;漏诊病灶132个,漏诊率为28.4%(132/464),病灶最大径为5～68mm,平均(15.2±8.5)mm,两组间病灶直径差异有统计学意义(t=9.52,P<0.001)。检出病灶和漏诊病灶最大径≤30mm、分布位于近膈顶位置以及存在肝硬化背景的比例分别为51.5%(171/332)vs96.2%(127/132)、44.3%(147/332)vs69.7%(92/132)、81.0%(269/332)vs97.7%(129/132),差异均有统计学意义(χ2值分别为82.16、24.43、21.60,P均<0.01)。结论肝癌病灶的大小及部位、肝硬化背景可能是造成常规超声漏诊原发性肝癌的主要原因。

The cause analysis of missing primary hepatic carcinoma lesions in conventional ultrasonography

Objective To analyse the causes of missing primary hepatic earcinoma lesions in conventional ultrasonography. Methods Totally 464 lesions in 344 patients were retrospectively analyzed. All lesions considered as primary hepatic carcinoma （PHC） in accordance with eurrent American Association for the Study of Liver Diseases （AASLD）guidelines were included in this study. All lesions underwent conventional uhrasonography and CT/MRI scan and were finally diagnosed as PHC. The sizes and locations of the lesions identified on CT/MRI images were regard as the referenee standards. In conventional ultrasonography, lesions were divided into detected and undetected groups. Comparing the detected group with the undetected group, factors such as sizes and segmental locations of lesions and the background of liver parenehyma lhat may cause PHC undetected by ultrasound were analyzed. Results The detected group had 332 lesions. The detection rate was 71.6% （332/464）. The maximum diameters of the lesions were 8-198 mm [ （48.9±40.3 ） cm ]. The undetected group has 132 lesions. The missed diagnosis rate was 28.4% （132/464）. The maximum diameters of the lesions were 5-68 mm[ （ 15.2±8.5 ） cm ]. The difference of lesion diameters between two groups was statistically significant （ t = 9. 52, P 〈 0. 001 ）. The proportions of lesions which maximum diameters were ≤ 30 nnn, was located near diaphragm and had cirrhosis background in the detected and undetected group were 51.5% （171/332） vs 96.2% （127/132） ,χ2 = 82.16,P 〈 0. 001 ;44.3% （147/332） vs 69.7% （92/132 ） ,χ2 = 24.43, P 〈 0. 001 ;81.0% （269/332） v s 97.7% （129/132） ,χ2 = 21.60, P 〈 0. 001. Conclusion The sizes and segmental locations of PHC lesions and the background of the liver parenchyma may cause sonographie invisibility.