肝脏局灶性病变的超声造影——一项成本效益研究。
Contrast enhanced ultrasound in focal liver lesions--a cost efficiency study.
作者信息
Sirli Roxana, Sporea Ioan, Martie Alina, Popescu Alina, Dănilă Mirela
机构信息
Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.
出版信息
Med Ultrason. 2010 Dec;12(4):280-5.
UNLABELLED
Contrast enhanced ultrasound (CEUS) has a well established role for the evaluation of focal liver lesions (FLL). The AIM of our paper was to evaluate if CEUS is a cost-efficient method for the first line evaluation of FLL.
MATERIAL AND METHOD
We performed a prospective study that included all the CEUS evaluations performed in our Department during a 6 months period (September 2009-March 2010). CEUS evaluation was performed with a Siemens Acuson S2000TM Ultrasound System following an intravenous bolus injection of 2.4 ml SonoVue(R) (Bracco). A CEUS examination was considered conclusive if, following contrast, the FLL had a typical enhancement pattern(after EFSUMB Guidelines 2008), allowing its classification as hemangioma, FNH, adenoma, hepatocellular carcinoma, metastasis, fatty-free area, focal fatty infiltration. We compared the costs of a CEUS positive diagnosis, to the cost of contrast CT and/or contrast MRI positive diagnosis. We also included the additional costs of CT and/or MRI, if CEUS was not conclusive. The cost of CEUS was calculated as the cost of 1/2 vial of SonoVue + the cost of abdominal ultrasound (150 + 30 = 180 RON). The costs of contrast CT scan and MRI were 285 and 650 RON respectively (mean costs practiced in Timisoara).
RESULTS
In our study were included 316 FLL: 163 (51.6 %) in patients without hepatitis and 153 (48.4 %) in patients with chronic hepatopathies (in 133 cases liver cirrhosis and in 20 cases chronic hepatitis). CEUS was conclusive in 250 (79.1%) of the 316 cases, the cost for the evaluation of these patients being 45,000 RON. For the other 66 patients, the diagnosis cost will include the cost of CEUS + the cost of contrast CT: 30,690 RON. If contrast MRI was used for the differential diagnosis, the cost would be 54,780 RON. So the total cost of diagnosing 316 FLL would be 75,690 RON or 99,780 RON. If contrast CT would be used as the first line diagnosis for the 316 FLL, the cost would be 90,060 RON, by CEUS saving 14,370 RON, or 45.5 RON/lesion (using contrast CT for the differential diagnosis). If contrast MRI would be used as the first line diagnosis, the cost would be 205,400 RON, by CEUS saving 105,620 RON, or 334.2 RON/lesion (using contrast MRI for the differential diagnosis).
CONCLUSION
CEUS is a cost-efficient method as a first line diagnosis of FLL as compared to first line contrast-CT or first-line MRI.
未标注
超声造影（CEUS）在局灶性肝病变（FLL）评估中具有既定作用。我们本文的目的是评估CEUS是否为FLL一线评估的经济有效方法。
材料与方法
我们进行了一项前瞻性研究，纳入了本部门在6个月期间（2009年9月至2010年3月）进行的所有CEUS评估。使用西门子Acuson S2000TM超声系统进行CEUS评估，静脉推注2.4毫升声诺维（博莱科）。如果在超声造影后FLL具有典型的增强模式（遵循2008年欧洲超声医学与生物学联合会指南），则CEUS检查被视为结论性的，从而可将其分类为血管瘤、局灶性结节性增生、腺瘤、肝细胞癌、转移瘤、无脂肪区、局灶性脂肪浸润。我们将CEUS阳性诊断的成本与对比增强CT和/或对比增强MRI阳性诊断的成本进行了比较。如果CEUS不是结论性的，我们还纳入了CT和/或MRI的额外成本。CEUS的成本计算为1/2瓶声诺维的成本加上腹部超声的成本（150 + 30 = 180罗马尼亚列伊）。对比增强CT扫描和MRI的成本分别为285和650罗马尼亚列伊（蒂米什瓦拉的平均成本）。
结果
我们的研究纳入了316个FLL：无肝炎患者中有163个（51.6%），慢性肝病患者中有153个（48.4%）（133例为肝硬化，20例为慢性肝炎）。在316例病例中，250例（79.1%）的CEUS检查是结论性的，评估这些患者的成本为45,000罗马尼亚列伊。对于其他66例患者，诊断成本将包括CEUS成本加上对比增强CT成本：30,690罗马尼亚列伊。如果使用对比增强MRI进行鉴别诊断，成本将为54,780罗马尼亚列伊。因此，诊断316个FLL的总成本将为75,690罗马尼亚列伊或99,780罗马尼亚列伊。如果将对比增强CT用作316个FLL的一线诊断，成本将为90,060罗马尼亚列伊，通过CEUS节省14,370罗马尼亚列伊，或每个病变节省45.5罗马尼亚列伊（使用对比增强CT进行鉴别诊断）。如果将对比增强MRI用作一线诊断，成本将为205,400罗马尼亚列伊，通过CEUS节省105,620罗马尼亚列伊，或每个病变节省334.2罗马尼亚列伊（使用对比增强MRI进行鉴别诊断）。
结论
与一线对比增强CT或一线MRI相比，CEUS作为FLL的一线诊断是一种经济有效的方法。
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