超声造影在脂肪肝背景下肝局灶性病变诊断中的应用价值

目的探讨超声造影在脂肪肝背景下肝局灶性病变的病灶检出和定性诊断等方面的应用价值。 方法对2018年1月至2020年7月在瑞金医院和瑞金无锡分院进行肝超声造影检查的108例轻中度脂肪肝患者（共153个病灶）的超声造影资料进行回顾性分析。部分病灶检查使用高帧频造影模式。所有的入组病灶最终由穿刺活检、手术病理证实、CT增强或MRI增强等其他影像学诊断经随访证实。比较常规超声与超声造影在病灶检出和定性诊断方面的应用价值，计算相应的诊断准确性、敏感度和特异度，采用χ²检验比较2种超声模式对于病灶良恶性诊断准确性的差异。 结果入组153个病灶中60个为良性，93个恶性，结果显示超声造影可以提高脂肪肝背景下肝局灶性病灶，尤其是微小转移瘤的检出率，其病灶检出率可由常规超声的78.43%（120/153）提高到98.69%（151/153），而对于病灶的良恶性诊断准确性可由69.93%提高到94.12%，差异具有统计学意义（χ²=11.719，P=0.0016），且敏感度和特异度均>91%，阳性预测值>94%。 结论超声造影可明显提高脂肪肝背景下肝局灶性病变特别是微小转移灶的检出率，大大提高肝局灶性病变的诊断准确性，为临床诊疗工作提供组织微循环灌注等重要诊断信息。

Value of contrast-enhanced ultrasound in diagnosis of focal liver lesions in the background of fatty liver

ObjectiveTo explore the application value of contrast-enhanced ultrasound in the detection and qualitative diagnosis of focal liver lesions in the background of fatty liver. MethodsFrom January 2018 to July 2020, 108 patients with mild or moderate fatty liver disease (153 lesions) who underwent contrast-enhanced ultrasound examinations at Ruijin Hospital and Wuxi Branch of Ruijin Hospital were retrospectively analyzed. Some of patients undertook the examination using high-frame-rate contrast-enhanced ultrasound mode. All the lesions were confirmed by pathology or by enhanced CT or MRI examination with follow-up. The accuracy, sensitivity, and specificity of conventional ultrasound and contrast-enhanced ultrasound in the detection and diagnosis of hepatic lesions were calculated, and χ² test was used to compare their accuracy in the differential diagnosis of benign and malignant lesions. ResultsA total of 60 benign lesions and 93 malignant tumors were included in the study. The results showed that CEUS can improve the detection rate of focal liver lesions, especially micrometastases, in the background of fatty liver; the detection rate of lesions increased from 78.43% (120/153) to 98.69% (151/153), while the accuracy increased from 69.93% to 94.12%, and the difference was statistically significant (χ²=11.719, P=0.0016). The sensitivity and specificity were both greater than 91%, and the positive predictive value was greater than 94%. ConclusionContrast-enhanced ultrasound can significantly improve the detection rate of focal liver lesions, especially micrometastases, and the diagnostic accuracy in the background of fatty liver. As a useful tool, it has important clinical application value in providing tissue microcirculation information for clinical diagnosis.