基于造影增强超声图像模式分类的肝脏肿瘤鉴别诊断前瞻性研究

Prospective study of differential diagnosis of hepatic tumors by pattern-based classification of contrast-enhanced sonography.

作者信息

Numata Kazushi, Isozaki Tetsuo, Morimoto Manabu, Sugimori Kazuya, Kunisaki Reiko, Morizane Toshio, Tanaka Katsuaki

机构信息

Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan.

出版信息

World J Gastroenterol. 2006 Oct 21;12(39):6290-8. doi: 10.3748/wjg.v12.i39.6290.

DOI:10.3748/wjg.v12.i39.6290

PMID:17072951

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4088136/

Abstract

AIM

To prospectively evaluate the usefulness of a pattern-based classification of contrast-enhanced sonographic findings for differential diagnosis of hepatic tumors.

METHODS

We evaluated the enhancement pattern of the contrast-enhanced sonography images in 586 patients with 586 hepatic lesions, consisting of 383 hepatocellular carcinomas, 89 metastases, and 114 hemangiomas. After injecting a galactose-palmitic acid contrast agent, lesions were scanned by contrast-enhanced harmonic gray-scale sonography in three phases: arterial, portal, and late. The enhancement patterns of the initial 303 lesions were classified retrospectively, and multiple logistic regression analysis was used to identify enhancement patterns that allowed differentiation between hepatic tumors. We then used the pattern-based classification of enhancement we had retrospectively devised to prospectively diagnose 283 liver tumors.

RESULTS

Seven enhancement patterns were found to be significant predictors of different hepatic tumors. The presence of homogeneous or heterogeneous enhancement both in the arterial and portal phase was the typical enhancement pattern for hepatocellular carcinoma, while the presence of peritumoral vessels in the arterial phase and ring enhancement or a perfusion defect in the portal phase was the typical enhancement pattern for metastases, and the presence of peripheral nodular enhancement both in the arterial and portal phase was the typical enhancement pattern for hemangioma. The sensitivity, specificity, and accuracy of prospective diagnosis based on the combinations of enhancement patterns, respectively, were 93.2%, 96.2%, and 94.0% for hepatocellular carcinoma, 87.9%, 99.6%, and 98.2% for metastasis, and 95.6%, 94.1%, and 94.3% for hemangioma.

CONCLUSION

The pattern-based classification of the contrast-enhanced sonographic findings is useful for differentiating among hepatic tumors.

摘要

目的

前瞻性评估基于模式的超声造影表现分类对肝肿瘤鉴别诊断的实用性。

方法

我们评估了586例患有586个肝病灶患者的超声造影图像增强模式，其中包括383例肝细胞癌、89例转移瘤和114例血管瘤。注射半乳糖-棕榈酸造影剂后，通过超声造影谐波灰阶超声在动脉期、门脉期和延迟期三个阶段对病灶进行扫描。对最初303个病灶的增强模式进行回顾性分类，并使用多元逻辑回归分析来识别可区分肝肿瘤的增强模式。然后，我们使用回顾性设计的基于模式的增强分类对283个肝肿瘤进行前瞻性诊断。

结果

发现七种增强模式是不同肝肿瘤的重要预测指标。动脉期和门脉期均出现均匀或不均匀增强是肝细胞癌的典型增强模式，而动脉期出现瘤周血管且门脉期出现环形增强或灌注缺损是转移瘤的典型增强模式，动脉期和门脉期均出现周边结节状增强是血管瘤的典型增强模式。基于增强模式组合的前瞻性诊断的敏感性、特异性和准确性，肝细胞癌分别为93.2%、96.2%和94.0%，转移瘤分别为87.9%、99.6%和98.2%，血管瘤分别为95.6%、94.1%和94.3%。