超声造影对＜2 cm肝病灶的鉴别诊断价值

黄志平　许松　杨贻金　郭德全　邓文娇　林霖

[关键词] 超声造影;肝病灶;鉴别诊断;穿刺活检;病理

[中图分类号] R445.1          [文献标识码] B          [文章编号] 1673-9701（2021）22-0131-05

Value of contrast-enhanced ultrasound in differential diagnosis of liver disease foci less than 2 cm

HUANG Zhiping   XU Song   YANG Yijin   GUO Dequan   DENG Wenjiao   LIN Lin

Department of Ultrasonography， Ganzhou City People′s Hospital in Jiangxi Province， Ganzhou   341000， China

[Abstract] Objective To explore the value of contrast-enhanced ultrasound （CEUS） in the differential diagnosis of benign and malignant liver disease foci less than 2 cm. Methods A total of 52 patients underwent routine liver ultrasound and CEUS examinations in our hospital from June 2019 to March 2020， and 41 patients with liver disease foci less than 2 cm were selected as the research subjects， and the diagnostic data of the two examination methods were analyzed. According to the probability of benign and malignant， the patients were divided into 5 categories for benign and malignant diagnosis and ROC curve analysis， and the value of the two examination methods in differential diagnosis of benign and malignant liver diseases less than 2 cm was compared. Results Among the 52 liver CEUS patients， 41 patients （78.85%） had liver disease foci less than 2 cm， including 3 patients with 2 foci and 38 patients with a single focus， and a total of 44 foci were observed. A total of 21 malignant foci and 23 benign foci were finally diagnosed. The sensitivity， specificity and accuracy of CEUS were 100.00%（21/21），91.30% （21/23） and 95.45%（42/44），respectively， while those of conventional ultrasound were 85.71%（18/21），60.87%（14/23） and 72.73%（32/44）， respectively. The area under the ROC curve of CEUS diagnosis （0.997） was larger than that of conventional ultrasound diagnosis （0.820， P<0.05）. Conclusion Contrast-enhanced ultrasound can observe the enhanced and subsided modes of foci radiography throughout the whole process. For small foci with a diameter <2 cm， CEUS has high sensitivity， specificity and accuracy， and strong ability of differential diagnosis， showing a good application prospect.

[Key words] Contrast-enhanced ultrasound （CEUS）; Liver disease foci; Differential diagnosis; Puncture biopsy; Pathology

肝結节通常是由于各种因素影响而引起肝脏纤维组织增生，从而使得肝小梁排列顺序紊乱而形成[1]。临床常见的肝结节病灶主要包含肝局灶性结节样增生、肝结节状再生性增生、肝硬化、肝腺瘤及肝部分结节样变[2]。当病患机体出现结节时，则表明其肝脏组织已经开始出现纤维化。因此，及时对肝结节进行有效诊断，并采取相应治疗措施，对改善疾病预后具有积极意义。我国是肝病大国，每年都有大量患者身受其害。做到早期准确诊断尤为重要。超声检查是肝脏病变首选的影像学检查方法，常规超声（二维超声和彩色多普勒超声）在肝脏病灶的检出方面具有很高的敏感性，但在病灶的定性方面相对较弱，尤其是小于2 cm的病灶，因病灶多无特征性，诊断价值弱于对比增强计算机断层成像（Computed tomography，CT）和对比增强核磁共振成像（Magnetic resonance imaging，MRI）[3]。随着超声造影（对比增强超声，Contrast enhanced ultrasound，CEUS）技术的发展，其在肝脏方面的应用越来越成熟，能够实时显示肝内病灶的血流灌注过程，提高定性诊断能力[4]。本研究分析超声造影对<2 cm肝病灶的鉴别诊断价值，现报道如下。