Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Medical Imaging, Shanghai, China.
J Ultrasound Med. 2019 Oct;38(10):2601-2608. doi: 10.1002/jum.14957. Epub 2019 Jan 30.
To retrospectively evaluate the value of contrast-enhanced ultrasound (CEUS) perfusion parameters in the differential diagnosis of hepatocellular carcinomas (HCCs) and metastatic liver tumors (MLTs) with hypervascularity.
Sixty-seven HCCs and 55 MLTs with arterial homogeneous/heterogeneous hyperenhancement on CEUS imaging and a normal liver background were included in this retrospective study. Six CEUS perfusion parameters were compared between HCCs and MLTs with different sizes and HCC differentiations: rise time (RT), time to peak (TTP), mean transit time, wash-out time (WT), maximum intensity (IMAX), and area under the curve (AUC). The area under the receiver operating characteristic curve (AUROC) was determined to compare the diagnostic efficacy of the parameters.
The RT, TTP, and WT were significant longer and the IMAX and AUC were significantly higher in HCCs than in MLTs. In distinguishing between HCCs and MLTs, the AUROC was highest for the WT (0.922; sensitivity, 85.1%; specificity, 89.6%); the AUC and IMAX had the second and third highest AUROCs (AUC: 0.855; sensitivity, 76.1%; specificity, 80.6%; IMAX: 0.827; sensitivity, 76.1%; specificity, 77.6%). The AUROC was lowest for the TTP and RT (TTP: 0.719; sensitivity, 70.1%; specificity, 61.2%; RT: 0.707; sensitivity, 67.2%; specificity, 65.7%). In HCCs, both the tumor size and degree of differentiation affected the IMAX, AUC, and WT. In MLTs, perfusion parameters were not influenced by the tumor size.
In HCCs and MLTs with hypervascularity and a normal liver background on CEUS imaging, various CEUS perfusion parameters, including IMAX, AUC, WT, RT, and TTP, differed significantly between tumor types. The WT may be the most useful parameter for differentiating between these tumors.
回顾性评估超声造影（CEUS）灌注参数在鉴别富血供肝细胞癌（HCC）和转移性肝肿瘤（MLT）中的价值。
本回顾性研究纳入了 67 个 HCC 和 55 个 MLT，这些肿瘤在 CEUS 成像上均表现为动脉期均匀/不均匀高增强，且背景肝脏正常。比较了不同大小和 HCC 分化程度的 HCC 和 MLT 之间的 6 个 CEUS 灌注参数：上升时间（RT）、达峰时间（TTP）、平均渡越时间、洗脱时间（WT）、最大强度（IMAX）和曲线下面积（AUC）。通过计算受试者工作特征曲线下面积（AUROC）来比较各参数的诊断效能。
与 MLT 相比，HCC 的 RT、TTP 和 WT 明显较长，而 IMAX 和 AUC 明显较高。在鉴别 HCC 和 MLT 时，WT 的 AUROC 最高（0.922；敏感性为 85.1%，特异性为 89.6%）；AUC 和 IMAX 的 AUROC 次之和第三（AUC：0.855；敏感性为 76.1%，特异性为 80.6%；IMAX：0.827；敏感性为 76.1%，特异性为 77.6%）。TTP 和 RT 的 AUROC 最低（TTP：0.719；敏感性为 70.1%，特异性为 61.2%；RT：0.707；敏感性为 67.2%，特异性为 65.7%）。在 HCC 中，肿瘤大小和分化程度均影响 IMAX、AUC 和 WT。在 MLT 中，灌注参数不受肿瘤大小的影响。
在 CEUS 成像上表现为富血供的 HCC 和 MLT 中，不同的 CEUS 灌注参数，包括 IMAX、AUC、WT、RT 和 TTP，在肿瘤类型之间有显著差异。WT 可能是鉴别这些肿瘤最有用的参数。
