Urhuț Marinela-Cristiana, Săndulescu Larisa Daniela, Ciocâlteu Adriana, Cazacu Sergiu Marian, Dănoiu Suzana
Department of Gastroenterology, Emergency County Hospital of Craiova, Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Diagnostics (Basel). 2023 Oct 23;13(20):3288. doi: 10.3390/diagnostics13203288.
Recent advances in the field of ultrasonography offer promising tools for the evaluation of liver tumors. We aim to assess the value of multimodal ultrasound in differentiating hepatocellular carcinomas (HCCs) from other liver lesions. We prospectively included 66 patients with 72 liver tumors. The histological analysis was the reference standard for the diagnosis of malignant liver lesions, and partially for benign tumors. All liver lesions were assessed by multiparametric ultrasound: standard ultrasound, contrast-enhanced ultrasound (CEUS), the point shear wave elastography (pSWE) using shear wave measurement (SWM) method and real-time tissue elastography (RTE). To diagnose HCCs, CEUS achieved a sensitivity, specificity, accuracy and positive predictive value (PPV) of 69.05%, 92.86%, 78.57% and 93.55%, respectively. The mean shear-wave velocity (Vs) value in HCCs was 1.59 ± 0.29 m/s, which was lower than non-HCC malignancies ( < 0.05). Using a cut-off value of 1.58 m/s, SWM achieved a sensitivity of 54.76%, and 82.35% specificity, for differentiating HCCs from other malignant lesions. The combination of SWM and CEUS showed higher sensitivity (79.55%) compared with each technique alone, while maintaining a high specificity (89.29%). In RTE, most HCCs (61.53%) had a mosaic pattern with dominant blue areas corresponding to type "c" elasticity. Elasticity type "c" was 70.59% predictive for HCCs. In conclusion, combining B-mode ultrasound, CEUS, pSWE and RTE can provide complementary diagnostic information and potentially decrease the requirements for other imaging modalities.
超声领域的最新进展为肝脏肿瘤的评估提供了有前景的工具。我们旨在评估多模态超声在鉴别肝细胞癌（HCC）与其他肝脏病变中的价值。我们前瞻性纳入了66例患有72个肝脏肿瘤的患者。组织学分析是诊断恶性肝脏病变的参考标准，部分用于良性肿瘤的诊断。所有肝脏病变均通过多参数超声进行评估：标准超声、对比增强超声（CEUS）、使用剪切波测量（SWM）方法的点剪切波弹性成像（pSWE）和实时组织弹性成像（RTE）。为诊断HCC，CEUS的敏感性、特异性、准确性和阳性预测值（PPV）分别为69.05%、92.86%、78.57%和93.55%。HCC中的平均剪切波速度（Vs）值为1.59±0.29米/秒，低于非HCC恶性肿瘤（<0.05）。使用1.58米/秒的临界值，SWM在鉴别HCC与其他恶性病变时的敏感性为54.76%，特异性为82.35%。与单独使用每种技术相比，SWM和CEUS的联合显示出更高的敏感性（79.55%），同时保持高特异性（89.29%）。在RTE中，大多数HCC（61.53%）具有马赛克模式，主要蓝色区域对应于“c”型弹性。“c”型弹性对HCC的预测性为70.59%。总之，结合B超、CEUS、pSWE和RTE可以提供互补的诊断信息，并可能减少对其他成像方式的需求。
