小肝癌的超声造影特征及其与病理分化程度相关性的临床研究

目的 探讨小肝癌的超声造影灌注特征与病理的相关性及其临床价值。方法 对常规超声发现的369个肝脏占位性病变行超声造影检查，分析其造影显像特征，并与病理结果进行比较。结果（1）与病理学诊断的恶性病灶245个和良性病灶124个进行对照，超声造影诊断小肝癌的灵敏度为98.8％（242／245），特异度92.7％（115／124），准确度96.7％（357／369），约登指数0.92，阳性似然比13.7，阴性似然比0.013。（2）小肝癌的超声造影特征性表现为动脉早期快速增强，动脉中晚期或门脉早期快速廓清，呈快进快退表象；其中肝脏恶性病灶的快进快退表现占87.2％（219／251），与良性病变的1.7％（2／118）比较，差异有统计学意义（P＜0.05）。（3）不同分化程度小肝癌的超声造影增强时间及达峰时间差异无统计学意义（P＞0.05）；高、中、低分化小肝癌的廓清时间分别为（102.4±2.36）s、（76.02±3.88）s和（49.40±4.95）s，分化程度高者的开始廓清时间明显晚于分化程度低者（P＜0.05）。结论 超声造影对小肝癌的诊断及其病理分化程度的评价具有重要的临床价值。

The correlation between the contrast-enhanced ultrasound and pathological differentiation in small hepato-cellular carcinoma

Objective To investigate the relationship between the contrast-enhanced ultrasound perfusion characteristics of small hepatocellular carcinoma（ SHCC） and pathology and its clinical value. Methods Three hundred and sixty-nine cases liver focus lesions detected by conventional ultrasound were examined by contrast-enhanced ultrasound（ CEUS） . The CEUS imaging characteristics and pathological results of SHCC were analyzed and compared. Results （ 1） Compared with pathological results of 254 malignant le-sions and 124 benign lesions,the sensitivity of CEUS in diagnosis of SHCC was 98？8%（ 242/245） , the specificity was 92？7%（ 115/124） , the accuracy was 96？7%（ 357/369） , Jorden index was 0？92, the positive likelihood ratio was 13？7, negative likelihood ratio was 0？013.（2） The CEUS characteristics of SHCC were rapid enhancement in early artery period, rapid clearance in late artery period or early portal period, that was characterized by fast enhancement and clearance. The enhancement pattern of fast in and out was ac-counted for 87？2%（ 219/251） in malignant tumor lesions compared with 1？7%（ 2/118） in benign lesions. The difference has statistical significance（P＆lt;0？05）.（3） The differences of CEUS enhancement time and peak time in different pathological differentiation of SHCC were no statistically significant（ P＆gt;0？05） , but the differences of time to clarify were statistically significant（ P＆lt;0？05） . Clearance time of the high differentiation,moderate differentiation and low differentiation of SHCC was（102？4＆#177;2？36）s,（76？02＆#177;3？88）s,（49？40＆#177; 4？95）s, respectively. The clearance time in high differentiation of SHCC was significantly longer than that of the low differentiation de-gree of SHCC（ P＆lt;0？05） . Conclusion CEUS has important clinical value in the diagnosis of SHCC and the evaluation of pathological differentiation degree.