Schellhaas B, Waldner M J, Görtz R S, Vitali F, Kielisch Ch, Pfeifer L, Strobel D, Janka R, Neurath M F, Wildner D
Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
Department of Radiology, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
Clin Hemorheol Microcirc. 2017;66(4):317-331. doi: 10.3233/CH-16238.
Contrast-enhanced ultrasound (CEUS) is a valuable tool in the diagnostic approach of focal liver lesions, but occasionally subjective and observer-dependent. Semiquantitative evaluation of dynamic CEUS (DCEUS) with standardised software programmes such as Dynamic Vascular Pattern (DVP) could help to improve diagnostic accuracy and objectivity in liver tumour assessment.
The present study aimed at evaluation of diagnostic accuracy of DVP in a clinical setting.
DVP images of 52 focal liver lesions [30 hepatocellular carcinomas (HCCs), 15 intrahepatic cholangiocellular carcinomas (ICCs), 7 focal nodular hyperplasias (FNHs)] were analysed by four blinded observers with different levels of CEUS-experience. Diagnostic accuracies for the assessment of dignity and entity were evaluated.
Mean sensitivity, specificity, positive and negative predictive value for detection of malignancy with DVP were 48.4% /67.8% /92.7% and 29.3%, respectively. Total diagnostic accuracies for dignity/entity were 63.9% /38.5% (HCC: 58.3% /25.8%; ICC: 73.3% /50%; FNH: 67.9% /67.9%). Interreader-agreement was moderate (κ= 0.42-0.58). Differential diagnosis between ICC and HCC was most challenging.
Although developed to improve diagnostic accuracy and objectivity in the assessment of focal liver lesions, DVP alone seems insufficient for differential diagnosis of HCC, ICC and FNH and cannot replace the skills of an experienced observer.
超声造影（CEUS）是肝脏局灶性病变诊断方法中的一种重要工具，但偶尔存在主观性且依赖观察者。使用动态血管模式（DVP）等标准化软件程序对动态CEUS（DCEUS）进行半定量评估有助于提高肝脏肿瘤评估的诊断准确性和客观性。
本研究旨在评估DVP在临床环境中的诊断准确性。
由四名对CEUS经验水平不同的观察者对52个肝脏局灶性病变[30例肝细胞癌（HCC）、15例肝内胆管细胞癌（ICC）、7例局灶性结节性增生（FNH）]的DVP图像进行分析。评估对病变性质和类型评估的诊断准确性。
使用DVP检测恶性肿瘤的平均敏感性、特异性、阳性预测值和阴性预测值分别为48.4%、67.8%、92.7%和29.3%。病变性质/类型的总诊断准确性分别为63.9%/38.5%（HCC：58.3%/25.8%；ICC：73.3%/50%；FNH：67.9%/67.9%）。观察者间一致性为中等（κ=0.42 - 0.58）。ICC与HCC之间的鉴别诊断最具挑战性。
尽管DVP旨在提高肝脏局灶性病变评估的诊断准确性和客观性，但单独使用DVP似乎不足以对HCC、ICC和FNH进行鉴别诊断，且不能替代经验丰富观察者的技能。
