Carvalho Cibele F, Chammas Maria C, Souza de Oliveira Claudia P M, Cogliati Bruno, Carrilho Flair J, Cerri Giovanni G
Instituto de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Department of Gastroenterology (LIM 07), School of Medicine, University of São Paulo, São Paulo, Brazil.
J Clin Exp Hepatol. 2013 Jun;3(2):96-101. doi: 10.1016/j.jceh.2013.04.004. Epub 2013 May 15.
BACKGROUND/OBJECTIVE: The early detection of focal hepatic lesions using ultrasound scanning is challenging, and this challenge becomes even greater in the presence of diffuse parenchymal disease. This study aimed to evaluate the diagnostic performance of elastography and contrast-enhanced ultrasonography (CEUS) in the early detection of hepatocellular lesions in an experimental rat model of nonalcoholic steatohepatitis (NASH).
B-mode and Doppler ultrasonography was performed weekly in 30 rats divided into a NASH group (n = 20) and a group without liver disease (n = 10). The animals underwent elastography and CEUS and were then euthanized. Liver nodules were assessed by histopathology.
Doppler mapping results of lesions with vascularization were considered indicative of malignancy, with a sensitivity of 29% before and 71% after contrast injection. The specificity was 71% before and 96% after CEUS. Elastograms of positive lesions showed areas of high stiffness, which were indicative of malignancy. This malignancy was confirmed by the histologic evaluation, with a sensitivity of 90% and a specificity of 60%. After CEUS analysis, 4 nodules were identified that were not observed on B-mode ultrasonography. Early wash-in was significantly associated with malignancy (sensitivity of 88% and specificity of 67%).
Both techniques allow for the correct diagnosis of well-differentiated to moderately differentiated hepatocellular carcinomas with good accuracy in an experimental rat model of NASH.
背景/目的：利用超声扫描早期检测肝脏局灶性病变具有挑战性，而在存在弥漫性实质疾病的情况下，这一挑战会变得更大。本研究旨在评估弹性成像和超声造影（CEUS）在非酒精性脂肪性肝炎（NASH）实验大鼠模型中早期检测肝细胞病变的诊断性能。
将30只大鼠分为NASH组（n = 20）和无肝脏疾病组（n = 10），每周进行一次B超和多普勒超声检查。对动物进行弹性成像和CEUS检查，然后实施安乐死。通过组织病理学评估肝结节。
有血管化的病变的多普勒成像结果被认为提示恶性，造影剂注射前的敏感性为29%，注射后为71%。CEUS检查前特异性为71%，检查后为96%。阳性病变的弹性图显示高硬度区域，提示恶性。组织学评估证实了这种恶性，敏感性为90%，特异性为60%。CEUS分析后，发现4个在B超检查中未观察到的结节。早期快速增强与恶性显著相关（敏感性为88%，特异性为67%）。
在NASH实验大鼠模型中，这两种技术都能以较高的准确性正确诊断高分化至中分化肝细胞癌。
