Giangregorio F, Comparato G, Marinone M G, Di Stasi M, Sbolli G, Aragona G, Tansini P, Fornari F
Gastroenterology and Hepatology Unit, Gugliemo da Saliceto Hospital, via Taverna 49, 29100 Piacenza, Italy.
J Ultrasound. 2009 Mar;12(1):12-21. doi: 10.1016/j.jus.2009.01.002. Epub 2009 Feb 26.
The commercially available Navigator system(©) (Esaote, Italy) allows easy 3D reconstruction of a single 2D acquisition of contrast-enhanced US (CEUS) imaging of the whole liver (with volumetric correction provided by the electromagnetic device of the Navigator(©)). The aim of our study was to compare the efficacy of this panoramic technique (Nav 3D CEUS) with that of conventional US and spiral CT in the detection of new hepatic lesions in patients treated for hepatocellular carcinoma (HCC).
From November 2006 to May 2007, we performed conventional US, Nav 3D CEUS, and spiral CT on 72 cirrhotic patients previously treated for 1 or more HCCs (M/F: 38/34; all HCV-positive; Child: A/B 58/14) (1 examination: 48 patients; 2 examinations: 20 patients; 3 examinations: 4 patients). Nav 3D CEUS was performed with SonoVue(©) (Bracco, Milan, Italy) as a contrast agent and Technos MPX(©) scanner (Esaote, Genoa, Italy). Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. Differences between the techniques were assessed with the chi-square test (SPSS release-15).
Definitive diagnoses (based on spiral CT and additional follow-up) were: 6 cases of local recurrence (LocRecs) in 4 patients, 49 new nodules >2 cm from a treated nodule (NewNods) in 34 patients, and 10 cases of multinodular recurrence consisting of 4 or more nodules (NewMulti). The remaining 24 patients (22 treated for 1-3 nodules, 2 treated for >3 nodules) remained recurrence-free. Conventional US correctly detected 29/49 NewNods, 9/10 NewMultis, and 3/6 LocRecs (sensitivity: 59.2%; specificity: 100%; diagnostic accuracy: 73.6%; PPV: 100%; NPV: 70.1%). Spiral CT detected 42/49 NewNods plus 1 that was a false positive, 9/10 NewMultis, and all 6 LocRecs (sensitivity: 85.7%; specificity: 95.7%; diagnostic accuracy: 90.9%; PPV: 97.7%; NPV: 75.9%). 3D NAV results were: 46N (+9 multinodularN and 6 LR), 3 false-negatives, and one false-positive (sensitivity: 93.9; specificity: 97.9%; diagnostic accuracy: 95.6; PPV: 97.9; NPV: 93.9).
3D Nav CEUS is significantly better than US and very similar to spiral CT for detection of new HCCs. This technique revealed the presence of lesions that could not be visualized with spiral CT.
市售的Navigator系统（©）（意大利百胜公司）能够轻松地对全肝对比增强超声（CEUS）成像的单次二维采集进行三维重建（通过Navigator（©）的电磁装置进行容积校正）。我们研究的目的是比较这种全景技术（Nav 3D CEUS）与传统超声及螺旋CT在检测接受过肝细胞癌（HCC）治疗患者新出现肝内病变方面的效能。
2006年11月至2007年5月，我们对72例曾接受过1次或多次HCC治疗的肝硬化患者进行了传统超声、Nav 3D CEUS及螺旋CT检查（男/女：38/34；均为丙型肝炎病毒阳性；Child分级：A/B级58/14）（1次检查：48例患者；2次检查：20例患者；3次检查：4例患者）。使用声诺维（©）（意大利米兰布拉科公司）作为造影剂，通过Technos MPX（©）扫描仪（意大利热那亚百胜公司）进行Nav 3D CEUS检查。评估了敏感性、特异性、诊断准确性以及阳性和阴性预测值（分别为PPV和NPV）。采用卡方检验（SPSS 15版）评估不同技术之间的差异。
最终诊断（基于螺旋CT及额外随访）为：4例患者出现6例局部复发（LocRecs），34例患者出现49个距已治疗结节＞2 cm的新结节（NewNods），10例患者出现由4个或更多结节组成的多结节复发（NewMulti）。其余24例患者（22例接受1 - 3个结节治疗，2例接受＞3个结节治疗）无复发。传统超声正确检测出29/49个NewNods、9/10个NewMultis以及3/6个LocRecs（敏感性：59.2%；特异性：100%；诊断准确性：73.6%；PPV：100%；NPV：70.1%）。螺旋CT检测出42/49个NewNods加1个假阳性、9/10个NewMultis以及全部6个LocRecs（敏感性：85.7%；特异性：95.7%；诊断准确性：90.9%；PPV：97.7%；NPV：75.9%）。3D NAV结果为：46个结节（+9个多结节及6个局部复发），3例假阴性，1例假阳性（敏感性：93.9%；特异性：97.9%；诊断准确性：95.6%；PPV：97.9%；NPV：93.9%）。
3D Nav CEUS在检测新出现的HCC方面显著优于超声，且与螺旋CT非常相似。该技术能够发现螺旋CT无法显示的病变。
