摘要
目的对比分析肝细胞腺瘤(HCA)与肝细胞癌(HCC)的超声造影特征差异。方法回顾性分析2014年3月至2019年5月在复旦大学附属中山医院超声科行肝超声造影检查并经病理证实为HCA的30例(共30个病灶)及HCC的56例(共56个病灶)患者的超声造影资料,超声造影动脉期增强方式、包膜下增强血管影、门脉期及延迟期减退变化等方面的差异比较使用χ^(2)检验或Fisher确切概率法。采用诊断四格表评价超声造影征象诊断HCA和HCC的效能。结果HCA和HCC在动脉期均呈高增强,且主要表现为整体增强(86.7%vs94.6%),两者在动脉期增强方式和达峰时均匀性方面比较,差异均无统计学意义(P均>0.05)。动脉期分别有43.3%(13/30)的HCA和8.9%(5/56)的HCC病灶见包膜下增强血管影(χ^(2)=11.971,P=0.001)。在门脉期,HCA呈高增强或等增强的比例高于HCC(13.4%/0vs43.3%/17.9%),差异具有统计学意义(χ^(2)=15.605,P<0.001)。延迟期HCC呈低增强的比例高于HCA(92.9%vs56.7%),差异具有统计学意义(χ^(2)=16.184,P<0.001)。以超声造影“动脉期高增强、门脉期及延迟期低增强”为依据诊断HCC,其敏感度、特异度、准确性分别为92.9%、80.0%、88.4%;以“动脉期高增强、门脉期及延迟期高增强或等增强”或“包膜下增强血管影”任何一种征象为依据诊断HCA,其敏感度、特异度、准确性分别为77.4%、89.1%、84.9%。结论HCA与HCC在超声造影动脉期包膜下增强血管影、门脉期及延迟期增强表现方面有差异,有助于两者的鉴别。
ObjectiveTo compare the contrast-enhanced ultrasound(CEUS)features between hepatocellular adenoma(HCA)and hepatocellular carcinoma(HCC).MethodsFrom March 2014 to May 2019,30 HCA patients with 30 lesions and 56 HCC patients with 56 lesions that were detected by CEUS examination and then confirmed pathologically at the Department of Ultrasound of Zhongshan Hospital,Fudan University were retrospectively analyzed.The differences in enhancement pattern in the arterial phase,subcapsular vessel hyperenhancement,and washout in the portal venous and delayed phases were compared by the Chi-square test or Fisher exact test.The efficacy of CEUS features in the diagnosis of HCA and HCC was evaluated by the four-grid diagnostic table method.ResultsAll HCA and HCC lesions showed hyperenhancement in the arterial phase,and both types of lesions mainly manifested as diffuse filling pattern(86.7%vs94.6%),with no statistically significant difference in enhancement pattern(P=0.417)or homogeneity at the peak time(P=0.483).Subcapsular vessel hyperenhancement was observed in 43.3%(13/30)of HCA and 8.9%(5/56)of HCC lesions(χ^(2)=11.971,P=0.001).In the portal venous phase,HCA more often showed hyper-or iso-enhancement than HCC(13.4%/0vs43.3%/17.9%),and the difference was statistically significant(χ^(2)=15.605,P<0.001).In the delayed phase,HCC more frequently exhibited hypo-enhancement than HCA(92.9%vs56.7%,χ^(2)=16.184,P<0.001).Based on"arterial hyper-enhancement and portal or delayed washout"on CEUS,the sensitivity,specificity,and accuracy for diagnosis of HCC were 92.9%,80.0%,and 88.4%,respectively.Based on either"arterial hyper-enhancement and sustained portal or delayed hyper-or iso-enhancement"or"subcapsular vessel hyperenhancement",the sensitivity,specificity,and accuracy for diagnosis of HCA were 77.4%,89.1%,and 84.9%,respectively.ConclusionCEUS features of subcapsular vessel hyperenhancement in the arterial phase and enhancement pattern in the portal venous and delayed phases are different between HCA and HCC,which are helpful
作者
陈凯玲
张炜彬
毛枫
韩红
李超伦
董怡
王文平
Kailing Chen;Weibin Zhang;Feng Mao;Hong Han;Chaolun Li;Yi Dong;Wenping Wang(Department of Ultrasound,Zhongshan Hospital of Fudan University,Shanghai 200032,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2022年第11期1218-1224,共7页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
国家自然科学基金项目(81571676)
上海市临床重点专科项目(shslczdzk03501)
上海市自然科学基金(19ZR1450700)
上海申康中心重大临床研究项目(SHDC2020CR1031B)
关键词
肝细胞腺瘤
肝细胞癌
超声造影
包膜下增强血管影
Hepatocellular adenoma
Hepatocellular carcinoma
Contrast-enhanced ultrasound
Subcapsular vessel hyperenhancement
