D'Onofrio M, Faccioli N, Zamboni G, Malagò R, Caffarri S, Fattovich G, Mucelli R Pozzi
Department of Radiology, B. Rossi University Hospital, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
Radiol Med. 2008 Oct;113(7):978-91. doi: 10.1007/s11547-008-0316-z. Epub 2008 Sep 8.
This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in characterising focal liver lesions in cirrhosis and to validate its use in lesions discovered during surveillance for hepatocellular carcinoma (HCC).
Between 2003 and 2006, 128 cirrhotic patients with focal liver lesions at baseline ultrasonography (US) were studied by power colour Doppler US (Doppler US) and CEUS. Serum alpha-fetoprotein (AFP) levels were assessed in all patients. Fine-needle biopsy or other reference modalities such as computed tomography (CT), magnetic resonance imaging (MRI) or digital subtraction angiography (DSA) were used as the gold standard. The accuracy of baseline US, Doppler US, AFP levels, combined US and AFP levels and combined US, Doppler US and CEUS in characterising focal liver lesions was assessed. Diagnostic performance was compared using the McNemar test.
A total of 207 focal liver lesions (101 benign and 106 malignant) were identified in 128 patients. CEUS sensitivity and specificity for lesion characterisation were 96.2% and 97.0%, respectively, whereas its positive and negative predictive values were 97.1% and 96.1%. CEUS accuracy was 96.6%, higher than that of US (72.0%), Doppler US (70.0%), AFP levels (65.7%), combined US and Doppler US (70.0%) and combined US and AFP levels (90.3%). The differences between US and CEUS were statistically significant (p<0.05).
CEUS can characterise focal liver lesions with 96.6% accuracy, a value higher than US, Doppler US, AFP levels, combined US and AFP levels and combined US and Doppler US. CEUS should therefore be used to characterise focal liver lesions detected during HCC surveillance of cirrhotic patients.
本研究旨在评估超声造影（CEUS）在肝硬化局灶性肝病变特征性诊断中的价值，并验证其在肝细胞癌（HCC）监测中发现的病变中的应用。
2003年至2006年期间，对128例基线超声（US）检查发现局灶性肝病变的肝硬化患者进行了能量彩色多普勒超声（Doppler US）和CEUS检查。对所有患者评估血清甲胎蛋白（AFP）水平。细针穿刺活检或其他参考检查方法，如计算机断层扫描（CT）、磁共振成像（MRI）或数字减影血管造影（DSA）被用作金标准。评估了基线US、Doppler US、AFP水平、联合US和AFP水平以及联合US、Doppler US和CEUS在局灶性肝病变特征性诊断中的准确性。使用McNemar检验比较诊断性能。
128例患者共发现207个局灶性肝病变（101个良性和106个恶性）。CEUS对病变特征性诊断的敏感性和特异性分别为96.2%和97.0%，而其阳性和阴性预测值分别为97.1%和96.1%。CEUS的准确性为96.6%，高于US（72.0%）、Doppler US（70.0%）、AFP水平（65.7%）、联合US和Doppler US（70.0%）以及联合US和AFP水平（90.3%）。US和CEUS之间的差异具有统计学意义（p<0.05）。
CEUS能够以96.6%的准确率对局灶性肝病变进行特征性诊断，该值高于US、Doppler US、AFP水平、联合US和AFP水平以及联合US和Doppler US。因此，CEUS应用于肝硬化患者HCC监测期间检测到的局灶性肝病变的特征性诊断。
