声脉冲辐射力成像技术在肝硬化结节及小肝癌鉴别诊断中的价值

目的 探讨声脉冲辐射力成像(acoustic radiation force impulse,ARFI)技术对肝硬化结节及小肝癌鉴别诊断的价值.方法 运用ARFI技术检测硬化增生结节组(35例,58个病灶)和小肝癌组(30例,30个病灶)病灶及背景肝实质的声触诊组织定量(virtual touch tissue quantification,VTQ),以剪切波速度(shear wave velocity,Swv)表示,对比两者间的差异.通过ROC曲线分析,求得最佳截断点.结果 硬化增生结节组与小肝癌组间病灶的SWV差异有统计学意义(P＜0.05),背景肝脏SWV的差异无统计学意义(P＞0.05);小肝癌组病灶与背景肝脏间的SWV差异有统计学意义(P＜0.05),硬化增生结节组两者间的SWV差异无统计学意义(P＞0.05).鉴别两组病灶的ROC曲线下面积为80.6％,截断值为2.46 m/s,敏感性为70％,特异性为96.6％,准确率为84.1％.结论 ARFI技术对肝硬化结节与小肝癌的鉴别诊断有较高的价值,为小肝癌的诊断提供依据,是肝硬化结节动态监测的有效方法.

Value of acoustic radiation force impulse in differential diagnosis of liver cirrhosis nodules and small hepatocellular carcinoma

Objective To evaluate the value of acoustic radiation force impulse (ARFI) in differential diagnosis of liver cirrhosis nodules and small hepatocellular carcinoma.Methods Thirty-five cases (58 lesions) of cirrhosis nodules and thirty patients (30 lesions) of small hepatocellular carcinoma were detected by ARFI to obtain the virtual touch tissue quantification (VTQ) of the lesions and the background liver tissue,which expressed in shear wave velocity.The difference between them was analyzed.Through the receiver operator characteristic (ROC) curve analysis,the area under the curve was obtained to discriminate liver cirrhosis nodules and small hepatocellular carcinoma.Results There was a statistically significant difference in VTQ of the lesions between the cirrhotic nodule group and the small hepatocellular carcinoma group (P ＜ 0.05),but no significant difference in VTQ of the liver parenchyma (P ＞ 0.05).A statistically significant difference of the VTQ between the lesions and liver parenchyma was found in the small hepatocellular carcinoma group (P ＜0.05),but no significant difference in the cirrhotic nodule group (P ＞ 0.05).The area under the ROC curve was 80.6％,based on 2.46 m/s as the cut-off point,the sensitivity,specificity and accuracy for differentially diagnosing liver cirrhosis nodules and small hepatocellular carcinoma were 70％,96.6％,84.1％.Conclusion ARFI technique is of great value in differential diagnosis of hepatocellular carcinoma and liver cirrhosis nodules.It can provide the basis for the diagnosis of small hepatocellular carcinoma and as an effective method for dynamic monitoring of hepatocellular carcinoma.