Wang Jing-Houng, Lu Sheng-Nan, Hung Chao-Hung, Chen Tai-Yi, Chen Chien-Hung, Changchien Chi-Sin, Lee Chuan-Mo
Division of Hepatogastroenterology, Department of Internal Medicine and Radiology, Kaohsiung Chang Gung Memorial Hospital, Koahsiung, Taiwan.
Liver Int. 2006 Oct;26(8):928-34. doi: 10.1111/j.1478-3231.2006.01318.x.
We evaluated the efficacy of contrast-enhanced ultrasonography (CEUS) for the characterization of small hepatic nodules (< or =2 cm) in cirrhosis patients.
Thirty cirrhosis patients with 30 hepatic nodules (1-2 cm) were enrolled in this study. Eighteen hepatic nodules were hepatocellular carcinomas (HCC) and 12 were benign lesions. CEUS was performed using microbubble contrast (Levovist). With surrounding hepatic parenchyma as a reference, two characteristics of hepatic nodules, including arterial phase enhancement (AE) and the absence of delayed phase enhancement (ADE), were evaluated as criteria for the diagnosis of HCC. A radiologist independently reviewed the dynamic computed tomographies (CT) of 26 hepatic nodules.
CEUS showed AE in 15 nodules (13 HCC and two benign) and ADE in 17 lesions (14 HCC and three benign). For HCC, the coincidental AE of both CEUS and dynamic CT was 40%. Using both AE and ADE for HCC diagnosis, the sensitivity, specificity, accuracy, positive predictive value and negative predictive values were 55.6%, 91.7%, 70%, 90.9% and 57.9%, respectively. When using either AE or ADE for HCC diagnosis, the same parameters were 94.4%, 66.7%, 83.3%, 81% and 88.9%, respectively. One benign hepatic nodule with both AE and ADE was diagnosed as HCC 29 months after the CEUS study.
A combination of characteristics of AE and ADE as determined by CEUS was highly specific for small HCCs in cirrhosis patients. Concurrent delayed phase imaging is useful in the diagnosis of small hypovascular HCCs.
我们评估了超声造影（CEUS）对肝硬化患者小肝结节（≤2 cm）特征的评估效能。
本研究纳入了30例肝硬化患者的30个肝结节（1 - 2 cm）。其中18个肝结节为肝细胞癌（HCC），12个为良性病变。使用微泡造影剂（声诺维）进行CEUS检查。以周围肝实质作为参照，将肝结节的两个特征，即动脉期增强（AE）和延迟期无增强（ADE），作为诊断HCC的标准。一名放射科医生独立回顾了26个肝结节的动态计算机断层扫描（CT）图像。
CEUS显示15个结节有AE（13个HCC和2个良性结节），17个病变有ADE（14个HCC和3个良性结节）。对于HCC，CEUS和动态CT的AE符合率为40%。联合使用AE和ADE诊断HCC时，敏感性、特异性、准确性、阳性预测值和阴性预测值分别为55.6%、91.7%、70%、90.9%和57.9%。当单独使用AE或ADE诊断HCC时，相同参数分别为94.4%、66.7%、83.3%、81%和88.9%。一个同时具有AE和ADE的良性肝结节在CEUS检查后29个月被诊断为HCC。
CEUS所确定的AE和ADE特征联合应用对肝硬化患者的小HCC具有高度特异性。同时进行延迟期成像对小乏血供HCC的诊断有用。
