增强CT和超声造影在肝硬化伴肝小结节样病灶鉴别诊断中的应用

目的分析增强CT(CECT)和超声造影(CEUS)在肝硬化伴肝小结节样病灶鉴别诊断中的应用价值。方法收集2018年5月至2019年2月我院收治的80例肝硬化患者临床资料及肝小结节样病灶的CECT与CEUS资料,分析相应影像学特点,记录CECT与CEUS相关参数,对照病理、分析两种方法的诊断价值。结果80例患者共发现90个直径小于等于3cm的肝局灶性微小结节,其中恶性病灶40个,良性病灶50个;恶性结节在动脉期呈高强化,门脉期等或低强化,平衡期低强化,三期CECT检出率比较差异有统计学意义(P<0.05);良性结节CEUS与CECT各期强化程度比较差异无统计学意义(P>0.05);CEUS下,良性结节开始增强时间、达峰时间、通过时间较恶性结节延长,而灌注指数、造影峰强度、曲线尖度小于恶性结节(P<0.05),两者AUC比较差异无统计学意义(P>0.05);CEUS诊断肝硬化伴肝小结节恶性的灵敏度、准确度高于CECT,两者特异度比较差异无统计学意义(P>0.05)。结论CEUS与常规CECT在肝硬化伴小结节病灶的良恶性判断上有一定提示意义,二者各具优势。

Application of Contrast-enhanced CT and Contrast-enhanced Ultrasound in Differential Diagnosis of Cirrhosis and Hepatic Nodular Lesions

Objective To analyze the application value of contrast-enhanced CT(CECT)and contrast-enhanced ultrasound(CEUS)in the identification of hepatic cirrhotic nodules.Methods Clinical data and CECT and CEUS data of 80 patients with liver cirrhosis admitted to our hospital from May 2018 to February 2019 were collected,corresponding imaging characteristics were analyzed,and related parameters of CECT and CEUS were recorded.The diagnostic value of the two methods was compared with that of pathology.Results A total of 90 hepatic cirrhotic nodules with diameters less than or equal to 3 cm were found in 80 patients,including 40 malignant lesions and 50 benign lesions.Malignant nodules were highly enhanced in arterial phase,equally or lowly enhanced in portal phase,lowly enhanced in equilibrium phase.There were statistically significant compared with CECT(P<0.05).There was no significant difference in enhancement degree of benign nodules between CEUS and CECT in all phase(P>0.05).Under CEUS,starting enhancement time,peak time and passage time of benign nodules were longer than those of malignant nodules,while perfusion index,contrast peak intensity and curve sharpness were less than those of malignant nodules(P<0.05).There was no significant difference in AUC between the two(P>0.05).The sensitivity and accuracy of CEUS in diagnosis of liver cirrhosis and hepatic nodules were higher than those of CECT.There was no significant difference in specificity between the two(P>0.05).Conclusion CEUS and conventional CECT help to the diagnosis of benign and malignant cirrhosis with nodular lesions,and each has its own advantages.