Platz Batista da Silva N, Schauer M, Hornung M, Lang S, Beyer L P, Wiesinger I, Stroszczynski C, Jung E M
Departement of Radiology, University Hospital Regensburg, Regensburg, Germany.
Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany.
Clin Hemorheol Microcirc. 2016;64(4):735-745. doi: 10.3233/CH-168029.
To evaluate the efficacy of strain elastography (SE) using semi-quantitative measurement methods compared to constrast enhanced ultrasound during liver tumor surgery (Io-CEUS) for dignity assessment of focal liver lesions(FLL).
Prospective data acquisition and retrospective analysis of US data of 100 patients (116 lesions) who underwent liver tumor surgery between 10/2010 and 03/2016. Retrospective reading of SE color patterns was performed establishing groups depending on dominant color (>50% blue = stiff, inhomogenous, >50% yellow/red/green = soft tissue). Semi-quantitative analysis was performed by Q-analysis based on a scale from 0 (soft) to 6 (stiff). 2 ROIs were placed centrally, 5 ROIs in the lesion's surrounding tissue. Io-CEUS was performed by bolus injection of 5-10 ml sulphurhexaflourid microbubbles evaluating wash-in- and -out- kinetics in arterial, portal venous and late phase. Histopathology after surgical resection served as goldstandard.
100 patients (m: 65, f: 35, mean age 60.5 years) with 116 liver lesions were included. Lesion's size ranged from 0.5 to 8.4 cm (mean 2.42 cm SD±1.44 cm). Postoperative histology showed 105 malignant and 11 benign lesions. Semi-quantitative analysis showed central indurations of >2.5 in 76/105 cases suggesting malignancy. 7 benign lesions displayed no central indurations correctly characterized benign by SE. ROC-analysis and Youden index showed a sensitivity of 72.4% and specificity of 63.6% assuming a cut-off of 2.5. Io-CEUS correctly characterized 103/105 as malignant. Sensitivity was 98%, specificity 72.7%.
Strain elastography is a valuable tool for non-invasive characterization of FLLs. Semi-quantitative intratumoral stiffness values of >2.5 suggested malignancy. However, sensitivity of Io-CEUS in detecting malignant lesions was higher compared to SE. In conclusion SE should be considered for routine use during intraoperative US in addition to Io-CEUS for optimization of curative liver surgery.
比较应变弹性成像（SE）使用半定量测量方法与肝脏肿瘤手术期间的对比增强超声（Io-CEUS）对肝脏局灶性病变（FLL）进行鉴别诊断的疗效。
对2010年10月至2016年3月期间接受肝脏肿瘤手术的100例患者（116个病变）的超声数据进行前瞻性数据采集和回顾性分析。对SE彩色模式进行回顾性解读，根据主要颜色（>50%蓝色=硬、不均匀，>50%黄色/红色/绿色=软组织）进行分组。基于从0（软）到6（硬）的量表通过Q分析进行半定量分析。在病变中心放置2个感兴趣区（ROI），在病变周围组织中放置5个ROI。通过团注5-10ml六氟化硫微泡进行Io-CEUS，评估动脉期、门静脉期和延迟期的血流灌注和流出动力学。手术切除后的组织病理学作为金标准。
纳入100例患者（男65例，女35例，平均年龄60.5岁），共116个肝脏病变。病变大小范围为0.5至8.4cm（平均2.42cm，标准差±1.44cm）。术后组织学显示105个恶性病变和11个良性病变。半定量分析显示，105例中有76例中央硬度>2.5，提示为恶性。7个良性病变未显示中央硬度，SE正确将其特征化为良性。ROC分析和尤登指数显示，假设临界值为2.5，敏感性为72.4%，特异性为63.6%。Io-CEUS正确将105例中的103例特征化为恶性。敏感性为98%，特异性为72.7%。
应变弹性成像是一种用于FLL非侵入性特征化的有价值工具。肿瘤内半定量硬度值>2.5提示为恶性。然而Io-CEUS检测恶性病变的敏感性高于SE。总之，除Io-CEUS外，术中超声检查时应考虑常规使用SE，以优化肝脏根治性手术。
