超声造影指导肝穿刺对肝脏占位性病变的诊断价值研究*

目的 评价超声造影指导肝穿刺诊断肝脏占位性病变的临床应用价值。方法 回顾性分析在我科行肝脏穿刺活检术的80例肝脏占位性病变患者的临床资料,其中50例术前行超声造影检查,30例术前行常规灰阶超声检查。比较两组的诊断效能。结果 与灰阶超声检查比,超声造影检查组显示病灶内部坏死区显著提高(56.0%对30.0%,P=0.024),取材成功率显著提高(100.0%对90.0% P=0.022),两组穿刺次数差异无统计学意义(3.0±0.8 对2.9±0.8,P=0.590);超声造影组诊断的灵敏度为97.8%、特异度为100%、准确率为98.0%,均显著高于灰阶超声组(分别为80.8%、75.0%和80.0%,P均<0.05)。结论 超声造影检查能够提高超声引导下肝脏穿刺活检术取材的成功率和诊断效能,值得临床应用。

Clinical application of contrast-enhanced ultrasonography in guiding liver biopsy in patients with space-occupying lesions

Objective The aim of this study was to evaluate the clinical application of contrast-enhanced ultrasonography (CEUS) in guiding liver biopsy in patients with space-occupying lesions (SOL). Methods The clinical data of 80 patients with SOL encounted in our Department of Ultrasound were retrospectively analyzed, and all underwent liver biopsy under US guidance. Before the liver biopsies, the CEUS was done in 50 cases, and the routine gray-scale US examination was performed in 30 cases. The diagnostic efficacy was compared between the two groups. Results The proportion of demonstrated necrotic areas in lesions in patients receiving CEUS was significantly increased (56.0% vs. 30.0%, P = 0.024), and the successful puncture rate in obtaining sampling was significantly higher (100.0% vs. 90.0%, P=0.022) as compared with those having gray-scale ultrasound scan; there was no significant difference in puncture times between the two groups (3.0±0.8 vs. 2.9±0.8, P=0.590); the sensitivity, specificity and accuracy by CEUS guidance were 97.8%, 100%, and 98.0%, significantly higher than in gray-scale ultrasound guidance (80.8%, 75.0% and 80.0%, respectively, all P< 0.05); no severe bleeding, pneumothorax, bile leakage and other complications occurred in all patients in the two groups. Conclusion The liver biopsies under CEUS guidance in patients with SOL could improve the puncture success and diagnostic efficacy, which warrants further clinical investigation.