D'Onofrio M, Crosara S, De Robertis R, Canestrini S, Cantisani V, Morana G, Mucelli R Pozzi
Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy.
Department of Radiology, University of Rome, Rome, Italy.
Ultrasound. 2014 May;22(2):91-8. doi: 10.1177/1742271X13513888. Epub 2013 Dec 13.
The aim of this study was to compare the diagnostic accuracy of the late phase of CEUS and the hepatobiliary phase of CE-MR with Gd-BOPTA in the characterization of focal liver lesions in terms of benignity and malignancy. A total of 147 solid focal liver lesions (38 focal nodular hyperplasias, 1 area of focal steatosis, 3 regenerative nodules, 8 adenomas, 11 cholangiocarcinomas, 36 hepatocellular carcinomas and 49 metastases) were retrospectively evaluated in a multicentre study, both with CEUS, using sulphur hexafluoride microbubbles (SonoVue, Bracco, Milan, Italy) and CE-MR, performed with Gd-BOPTA (Multihance, Bracco, Milan, Italy). All lesions thought to be malignant were cytohistologically proven, while all lesions thought to be benign were followed up. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy were calculated for the late phase of CEUS and the hepatobiliary phase of CE-MRI, respectively, and in combination. Analysis of data revealed 42 benign and 105 malignant focal liver lesions. We postulated that all hypoechoic/hypointense lesions on the two phases were malignant. The diagnostic errors were 13/147 (8.8%) by CEUS and 12/147 (8.2%) by CE-MR. Sensitivity, specificity, PPV, NPV and accuracy of the late phase of CEUS were 90%, 93%, 97%, 80% and 91%, 93%, 97%, 81% and 92% for the hepatobiliary phase of CE-MRI, respectively. If we considered both techniques, the misdiagnosis diminished to 3/147 (2%) and sensitivity, specificity, PPV, NPV and accuracy were 98%, 98%, 99%, 95% and 98%. The combination of the late phase of CEUS and the hepatobiliary phase of CE-MR in the characterization of solid focal liver lesions in terms of benignity and malignancy is more accurate than the two techniques used separately.
本研究旨在比较超声造影（CEUS）晚期和钆贝葡胺增强磁共振成像（CE-MR）肝胆期对肝脏局灶性病变良恶性特征的诊断准确性。在一项多中心研究中，对147个肝脏实性局灶性病变（38个局灶性结节性增生、1个局灶性脂肪变性区域、3个再生结节、8个腺瘤、11个胆管癌、36个肝细胞癌和49个转移瘤）进行了回顾性评估，同时采用六氟化硫微泡（声诺维，意大利布瑞科公司，米兰）进行CEUS检查，并使用钆贝葡胺（Multihance，意大利布瑞科公司，米兰）进行CE-MR检查。所有疑似恶性的病变均经细胞组织学证实，而所有疑似良性的病变均进行了随访。分别计算了CEUS晚期和CE-MRI肝胆期以及两者联合应用时的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。数据分析显示有42个良性和105个恶性肝脏局灶性病变。我们假定在这两个阶段均表现为低回声/低信号的病变为恶性。CEUS的诊断错误为13/147（8.8%），CE-MR的诊断错误为12/147（8.2%）。CEUS晚期的敏感性、特异性、PPV、NPV和准确性分别为90%、93%、97%、80%和92%，CE-MRI肝胆期分别为93%、97%、81%和92%。如果同时考虑两种技术，误诊率降至3/147（2%），敏感性、特异性、PPV、NPV和准确性分别为98%、98%、99%、95%和98%。在对肝脏实性局灶性病变的良恶性特征进行鉴别时，CEUS晚期和CE-MR肝胆期联合应用比单独使用这两种技术更准确。
