实时超声造影定量分析鉴别原发性肝细胞癌及肝硬化结节.docVIP

实时超声造影定量分析鉴别原发性肝细胞癌及肝硬化结节 　 作者：华兴 李锐 张萍 郭燕丽 郭爱民 【摘要】 目的 评价实时超声造影时间强度曲线定量分析在鉴别原发性肝细胞癌和肝硬化结节中的应用价值。方法 选取52例患者，其中原发性肝细胞癌26例，肝硬化结节26例。以声诺维2.4 ml行低机械指数(MIlt;0.09)实时超声造影后，用超声仪自带软件对病变内部灰阶强度变化绘制时间强度曲线(timeintensity curve，TIC)，计算并比较两者峰值强度(peak intensity，PI)、峰值时间(peak time，PT)、曲线下降斜率(descending slop,DS)、曲线下面积(area under curve，AUC)和持续增强时间(enhancement duration,ED)。结果 所有病变造影后均呈动态增强变化。原发性肝细胞癌组PT与ED分别为(21.06±10.09)s和(45.74±11.62)s明显小于肝硬化结节组的(33.58±10.60)s和(94.20±19.92s)(Plt;0.01)，而PI、DS及AUC在原发性肝细胞癌及肝硬化结节组之间差异无统计学意义(Pgt;0.05)。结论 低机械指数实时超声造影TIC定量分析能鉴别原发性肝细胞癌和肝硬化结节，PT及ED可作为其有效指标。 【关键词】 超声造影； 时间强度曲线； 肝肿瘤； 肝硬化 　　【Abstract】 Objective To evaluate the quantitative analysis of timeintensity curve (TIC) after realtime ultrasonography in the differential diagnosis of primary hepatocellular carcinoma and liver cirrhotic nodule. Methods There were 52 patients including 26 with primary hepatocellular carcinoma and 26 with liver cirrhotic nodules. Low mechanical index (MIlt;0.09) realtime ultrasonography was performed with 2.4 ml SonoVue in all patients, then TIC was drawn. The peak intensity (PI), peak time (PT), descending slop (DS), area under curve (AUC) and enhancement duration (ED) were calculated and compared between two diseases. Results The gray scale was dynamically enhanced in all the lesions. The PT and ED in the primary hepatocellular carcinomas were (21.06±10.09) s and (45.74±11.62) s, shorter than (33.58±10.60) s and (94.20±19.92) s in liver cirrhotic nodules (Plt;0.01). No statistical difference existed between the two diseases in PI, DS and AUC (Pgt;0.05). Conclusions The quantitative analysis with TIC after low mechanical index realtime ultrasonography can differentiate primary hepatocellular carcinoma and liver cirrhotic nodule, while PT and ED can be the valuable parameters. 【Key words】 Ultrasonography; Timeintensity curve; Liver neoplasm; Liver cirrhosis 原发性肝细胞癌(hepatocellular carcinoma,HCC)患者绝大多数伴有肝硬化病史。病理学将肝硬化结节分为再生结节和不典型增生结节。对于肝硬化再生结节与HCC的鉴别诊断，常规影像学方法尚缺乏敏感性和特