Xu Ming, Pan Fu-Shun, Wang Wei, Zhang Xiao-Er, Li Xiao-Ju, Hong Yu, Zhou Lu-Yao, Xie Xiao-Yan, Lyu Ming-de
Department of Medical Ultrasonics, the First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Medical Ultrasonics, the First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China.
Clin Imaging. 2018 Sep-Oct;51:311-317. doi: 10.1016/j.clinimag.2018.06.017. Epub 2018 Jun 21.
To investigate the combined use of ultrasound together with clinical features to differentiate infantile hepatic hemangioma (IHH) from other focal liver lesions (FLLs) in children and to compare the efficacy of the combined method to that of CECT/MRI.
The location, number, size and appearance of the tumors were evaluated in 45 children with IHH. Another 45 children with FLL were randomly selected as a control group. Independent factors for predicting IHH versus FLLs were evaluated. The diagnostic performance of the clinical and ultrasound features was compared with CECT/MRI.
Compared with the control FLL group, the IHH group had a younger age at diagnosis (P = 0.008), lower alpha-fetoprotein (AFP) levels (P = 0.000), smaller lesion sizes (P = 0.000), and a higher tumor proportion with a resistance index (RI) of <0.7. Multiple logistic regression analysis showed that age, size, RI and AFP were independent factors for predicting IHH. Receiver operating characteristic (ROC) curve analysis showed that the AUC (area under the curve) of the four combined independent factors was 0.881 (95% CI: 0.744-0.960), while the AUC for the CECT/MRI method was 0.905 (95% CI: 0.774-0.973), and the combined AUC for the independent factors and CECT/MRI was 0.929 (95% CI: 0.805-0.985). There were not statistically significant among the three AUCs (P > 0.05).
CECT/MRI was the effective diagnostic indicator for IHH. However, the combined clinical and ultrasound diagnoses, including age at diagnosis, lesion size, RI and AFP, can achieve the same effectiveness as CECT/MRI.
探讨超声联合临床特征鉴别儿童肝内婴儿型血管瘤（IHH）与其他肝脏局灶性病变（FLLs）的价值，并比较该联合方法与CT增强扫描/磁共振成像（CECT/MRI）的诊断效能。
对45例IHH患儿的肿瘤位置、数量、大小及形态进行评估。另随机选取45例FLL患儿作为对照组。评估预测IHH与FLLs的独立因素。将临床及超声特征的诊断效能与CECT/MRI进行比较。
与对照组FLL相比，IHH组诊断时年龄更小（P = 0.008），甲胎蛋白（AFP）水平更低（P = 0.000），病变更小（P = 0.000），阻力指数（RI）<0.7的肿瘤比例更高。多因素logistic回归分析显示，年龄、大小、RI及AFP是预测IHH的独立因素。受试者工作特征（ROC）曲线分析显示，4个联合独立因素的曲线下面积（AUC）为0.881（95%CI：0.744 - 0.960），而CECT/MRI方法的AUC为0.905（95%CI：0.774 - 0.973），独立因素与CECT/MRI联合的AUC为0.929（95%CI：0.805 - 0.985）。三者AUC差异无统计学意义（P>0.05）。
CECT/MRI是IHH的有效诊断指标。然而，临床与超声联合诊断，包括诊断时年龄、病变大小、RI及AFP，可达到与CECT/MRI相同的诊断效能。
