弹性成像5分评分法与应变率比值法鉴别诊断肝脏良恶性病变

目的 比较弹性成像5分评分法与应变率比值法对肝脏良恶性病变的鉴别诊断价值。 方法 对165例患者(共183个肝脏局灶性病变)进行肝脏弹性成像检查,分别对病灶进行弹性评分及应变率比值测定。以病理结果作为金标准,构建ROC曲线并计算曲线下面积,分别计算弹性评分法和应变率比值用于鉴别诊断肝脏良恶性肿瘤的敏感度、特异度、准确率、阳性预测值和阴性预测值;比较两种方法对肝脏局灶性病变的诊断效能。 结果 采用应变率比值鉴别诊断肝脏良恶性病灶时,曲线下面积为0.85;采用弹性评分时,曲线下面积为0.82,二者差异无统计学意义(P=0.14)。应变率比值诊断肝脏良恶性肿瘤的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为71.26%(62/87)、91.67%(88/96)、81.97%(150/183)、88.57%(62/70)、77.88%(88/113);弹性评分诊断肝脏恶性肿瘤的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为88.51%(77/87)、60.42%(58/96)、73.77%(135/183)、66.96%(77/115)、85.29%(58/88)。应变率比值法的特异度高于弹性评分法(P<0.05),但其敏感度较低(P<0.05),二者准确率差异无统计学意义(P>0.05),二者诊断能力的差异主要体现在弹性评分为3分的病灶中。 结论 应用弹性成像鉴别诊断肝脏局灶性病变的良恶性时,应变率比值法及弹性评分法各有优缺点,在临床应用中应结合具体情况选择合理方法。

Ultrasonic elastography in differential diagnosis of benign and malignant hepatic lesion: Strain ratio vs. 5-point scale criteria

Objective To compare the value of 5-point scale criteria and strain ratio in differential diagnosis of benign and malignant focal hepatic lesions. Methods Totally 165 patients with 183 focal hepatic lesions underwent ultrasonic elasticity. Then the elasticity score and strain ratio were measured. Taking pathological result as the golden standard, ROC curves were constructed and the area under the ROC curve (AUC) was calculated. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated, respectively. The diagnostic performance of these 2 methods was evaluated. Results AUC of strain ratio and 5-point scale criteria was 0.85 and 0.82, respectively (P=0.14).The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of strain ratio was 71.26% (62/87), 91.67% (88/96), 81.97% (150/183), 88.57% (62/70), 77.88% (88/113), respectively, while for 5-point scale criteria was 88.51% (77/87), 60.42% (58/96), 73.77% (135/183), 66.96% (77/115), 85.29% (58/88), respectively. Compared to 5-point scale criteria, strain ratio had higher specificity and lower sensitivity (both P<0.05). The accuracy of two methods showed no significant difference (P>0.05). Among those lesions assigned as score 3, the diagnostic performance of two methods was varied. Conclusion Five-point scale criteria and strain ratio possess specific features in differentiating hepatic benign and malignant focal lesions, and should be properly applied in practical situations.