声脉冲辐射力成像技术鉴别诊断肝脏良恶性局灶性病变

目的探讨声脉冲辐射力成像技术(ARFI)对肝脏良恶性局灶性病变的鉴别诊断价值。方法对64例患者76个肝脏局灶性病变进行ARFI检查并分析,包括声触诊组织成像技术(VTI)和声触诊组织量化技术(VTQ)。所有患者均经手术或穿刺病理证实或两种增强影像学检查(CEUS、CT、MRI)确诊。采用ROC曲线评价剪切波速(SWV)对肝脏局灶性病变良恶性的鉴别诊断价值,并确定临界点。结果 VTI声像图中,31个(31/40,77.50%)恶性病灶和13个(13/36,36.11%)良性病灶呈灰黑色(P<0.05);良性病灶SWV明显低于恶性病灶(1.67±0.61)m/s vs(2.80±1.07)m/s,P<0.01)。以SWV=2.04m/s为临界点鉴别肝脏局灶性病变的良恶性,其敏感度、特异度和准确率分别是82.50%、80.60%和81.58%。结论 ARFI有助于鉴别诊断肝脏良恶性局灶性病变,具有良好的临床应用前景。

Acoustic radiation force impulse elastography in differential diagnosis of benign and malignant focal lesions of the liver

Objective To observe the value of acoustic radiation force impulse (ARFI) elastography in the differential diagnosis of benign and malignant focal liver lesions. Methods ARFI elastography was performed in 64 patients with totally 76 focal liver lesions. Elastographic images of virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ) were obtained and analyzed. All patients were confirmed through surgery or biopsy pathology or by any of two enhanced imaging including CEUS, CT and MRI. The cut-off point for shear wave velocity (SWV) was obtained with ROC curve analysis, which was used to assess diagnostic performance. Results On the elastographic images of VTI, 31 malignant liver lesions and 13 (13/36, 36.11%) benign liver lesions appeared darker (P<0.05) compared with the surrounding liver parenchyma. SWV of benign lesions was significantly lower than that of malignant ones ( m/s vs m/s, P<0.01). With a cut-off value of 2.04 m/s for shear wave velocity, the sensitivity, the specificity and accuracy rate in discriminating malignant liver lesions from benign liver lesions was 82.50%, 80.60% and 81.58%, respectively. Conclusion ARFI elastography is helpful in differential diagnosis of benign and malignant focal liver lesions, and has a broad application prospects in clinic.