Yue Wen-Wen, Wang Shuo, Xu Hui-Xiong, Sun Li-Ping, Guo Le-Hang, Bo Xiao-Wan, Li Xiao-Long, Zhao Chong-Ke, Wang Dan, Liu Bo-Ji
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Department of Ultrasound, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Clin Hemorheol Microcirc. 2016 Nov 25;64(2):177-188. doi: 10.3233/CH-162060.
To evaluate the diagnostic performance of parametric imaging with contrast-enhanced ultrasound(CEUS) for differentiating hepatocellular carcinoma(HCC) from metastatic liver cancer(MLC).
30 HCCs (mean diameter, 3.6±1.3 cm; range, 2.1-5.0 cm) and 30 MLCs (mean diameter, 2.8±1.5 cm; range, 1.2-5.0 cm) pathologically diagnosed or confirmed by clinical criteria that underwent CEUS were randomly included. CEUS was carried out using a multifrequency transducer (2-4 MHz) and a bolus injection of 2.4 mL SonoVue. The CEUS clips of the targeted lesion were recorded continuously for 6 minutes. By analyzing CEUS clips, parametric image could be obtained using the SonoLiver® software automatically. Quantitative parameters were compared between HCC and MLC groups. Receiver operating characteristic (ROC) curve analysis was further performed on parameters with significant difference between two groups.
On parametric imaging, the maximum intensity, rise time, time to peak, mean transit time and washout time for HCC and MLC were 185.6±148.0 vs. 95.2±58.6 (P = 0.003), 25.7±6.3 s vs. 23.8±8.8 s (P = 0.341), 30.7±7.9 s vs. 27.8±10.5 s (P = 0.246), 90.2±45.7 s vs. 89.3±40.3 s (P = 0.805), 63.4±29.5 s vs. 37.2±33.8 s (P = 0.005), respectively. ROC analysis was further performed for washout time and it showed a cut-off point of 43.765 s for the differentiation between HCC and MLC, with the AUC value of 0.780 (95% CI: 0.646-0.914). The corresponding diagnostic specificity, sensitivity and accuracy were 72.0%, 84.6% and 78.4% respectively.
Parametric imaging of CEUS can display perfusion effects of HCC and MLC objectively and visually and washout time may serve as a useful parameter on the differential diagnosis between HCC and MLC.
评估超声造影（CEUS）参数成像对肝细胞癌（HCC）与肝转移癌（MLC）的鉴别诊断价值。
随机纳入经病理诊断或临床标准确诊且接受CEUS检查的30例HCC（平均直径3.6±1.3 cm；范围2.1 - 5.0 cm）和30例MLC（平均直径2.8±1.5 cm；范围1.2 - 5.0 cm）。使用多频探头（2 - 4 MHz）及团注2.4 mL声诺维进行CEUS检查。对目标病灶的CEUS图像连续记录6分钟。通过分析CEUS图像，使用SonoLiver®软件自动获取参数图像。比较HCC组和MLC组的定量参数。对两组间有显著差异的参数进一步进行受试者操作特征（ROC）曲线分析。
在参数成像上，HCC和MLC的最大强度、上升时间、达峰时间、平均通过时间和廓清时间分别为185.6±148.0 vs. 95.2±58.6（P = 0.003）、25. 7±6.3 s vs. 23.8±8.8 s（P = 0.341）、30.7±7.9 s vs. 27.8±10.5 s（P = 0.246）、90.2±45.7 s vs. 89.3±40.3 s（P = 0.805）、63.4±29.5 s vs. 37.2±33.8 s（P = 0.005）。对廓清时间进一步进行ROC分析，结果显示HCC与MLC鉴别的截断点为43.765 s，曲线下面积（AUC）值为0.78 0（95%CI：0.646 - 0.914）。相应的诊断特异性、敏感性和准确性分别为72.0%、84.6%和78.4%。
CEUS参数成像能客观、直观地显示HCC和MLC的灌注情况，廓清时间可作为HCC与MLC鉴别诊断的有用参数。
