实时弹性成像 - 肝硬化中小肝细胞癌的一种非侵入性诊断方法。

Real time elastography - a non-invasive diagnostic method of small hepatocellular carcinoma in cirrhosis.

机构信息

Fundeni Clinical Institute of Digestive Diseases, Liver Transplantation, Bucharest, Romania.

出版信息

J Gastrointestin Liver Dis. 2009 Dec;18(4):439-46.

PMID:20076816

Abstract

BACKGROUND

Small nodules (under 3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC).

AIM

To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients.

METHODS

42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed.

RESULTS

595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4 +/- 0.7 years and 69% patients were in Child-Pugh class A, 19% class B, 11% class C. For the mean intensity of green color AUROC=0.81, a cut-off value under 108.7 being diagnostic for HCC with a Sp=91.1%, Se=50%, PPV=92.1%, NPV=47.1%. Mean intensity of blue color proved to be an excellent diagnostic tool for HCC (AUROC=0.94); for a cut-off value greater than 128.9, Sp=92.2%, Se=78.9%, PPV=95.4%, NPV=68%. Independent predictive factors of HCC for a small nodule in cirrhotic patients were: blue color over 128.9 at sonoelastography and hypervascular appearance at Doppler US.

CONCLUSIONS

US elastography is a promising method for the non-invasive diagnosis of early HCC. Blue color at elastography and hypervascular aspects are independent predictors of HCC.

摘要

背景

在肝硬化患者的超声（US）检查中发现的小（<3cm）结节代表了对肝细胞癌（HCC）进行非侵入性诊断的最具挑战性的类别。

目的

评估实时超声弹性成像作为诊断肝硬化患者小 HCC 结节的非侵入性工具。

方法

对 42 例 58 个结节（1-3cm）的肝硬化患者进行实时弹性成像（日立 EUB-6500）评估；使用半定量方法测量红色、蓝色、绿色的平均颜色强度。对每个弹性成像图像的颜色直方图进行分析，以量化结节组织与肝硬化肝组织的弹性。构建 AUC 曲线以确定最佳截断点以区分结节的恶性特征。进行单变量和多变量逻辑回归分析。

结果

分析了来自 42 例患者（25 名男性；17 名女性）的 595 个超声弹性成像图像。平均年龄为 56.4±0.7 岁，69%的患者为 Child-Pugh 分级 A，19%为 B，11%为 C。对于绿色平均颜色强度，AUC=0.81，截断值<108.7 对 HCC 的诊断具有 91.1%的特异性、50%的敏感性、92.1%的阳性预测值、47.1%的阴性预测值。蓝色平均颜色强度被证明是 HCC 的极好诊断工具（AUC=0.94）；截断值>128.9 时，特异性为 92.2%、敏感性为 78.9%、阳性预测值为 95.4%、阴性预测值为 68%。肝硬化患者小结节 HCC 的独立预测因素为：超声弹性成像中蓝色>128.9 和多普勒超声中的高血流表现。