超声造影联合 LR-M 分类标准鉴别肝癌高危人群肝恶性结节。
Dynamic Contrast-Enhanced Ultrasonography Combined With LR-M Classification Criteria for Differentiating Malignant Liver Nodules at High Risk for Hepatocellular Carcinoma.
机构信息
Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China.
Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China.
出版信息
Ultrasound Med Biol. 2024 Jul;50(7):1028-1033. doi: 10.1016/j.ultrasmedbio.2024.03.016. Epub 2024 Apr 17.
OBJECTIVE
We aimed to investigate the value of quantitative parameters derived from dynamic contrast-enhanced ultrasonography (DCE-US) and a combination of these quantitative parameters with the LR-M classification criteria in distinguishing hepatocellular carcinoma (HCC) nodules and non-HCC malignancies.
METHODS
HCC and non-HCC malignant nodules were grouped using pathologic results, and each nodule was classified using CEUS LI-RADS 2017. Quantitative CEUS analysis of each nodule was performed using VueBox, and quantitative parameters were compared between the HCC and non-HCC groups. The diagnostic efficacy of the LR-5 category for HCC was analyzed using the LR-M classification criteria along with time-related quantitative parameters.
RESULTS
Of the 190 malignant liver nodules, 137 and 53 were HCCs and non-HCC malignancies, respectively. The median values of quantitative parameters RT (rise time), TTP (time to peak), mTTl (mean transit time local), and FT (fall time) in the non-HCC malignant group were lower than those in the HCC group, with p < 0.05. There was a statistically significant difference in WiAUC (wash-in area under the curve), WoAUC (wash-out area under the curve), WiWoAUC (wash-in and wash-out area under the curve), and WoR (wash-out rate) values between HCC and non-HCC malignant groups, with p < 0.05. Using LR-M washout time <60 s and FT ≤21.2 s as the new diagnostic standard, the LR-5 category showed a sensitivity of 83.9%, specificity of 96.2%, and positive predictive value of 98.3% for HCC diagnosis.
CONCLUSION
DCE-US can facilitate the distinction of HCCs and non-HCC malignancies. Non-HCC malignancies present with earlier peak enhancement and more rapid and marked washout than HCC nodules. The combination of the LR-M classification criteria and FT ≤21.2 s can significantly improve the diagnostic sensitivity of the LR-5 category for HCC.
目的
本研究旨在探讨从动态对比增强超声（DCE-US）获得的定量参数以及这些定量参数与 LR-M 分类标准相结合在鉴别肝细胞癌（HCC）结节和非 HCC 恶性肿瘤中的价值。
方法
根据病理结果将 HCC 和非 HCC 恶性结节分组，使用 CEUS LI-RADS 2017 对每个结节进行分类。使用 VueBox 对每个结节进行定量 CEUS 分析，并比较 HCC 和非 HCC 组之间的定量参数。使用 LR-M 分类标准结合时间相关定量参数分析 LR-5 类别对 HCC 的诊断效能。
结果
在 190 个恶性肝结节中，137 个为 HCC，53 个为非 HCC 恶性肿瘤。非 HCC 恶性肿瘤组的定量参数 RT（上升时间）、TTP（达峰时间）、mTTl（局部平均通过时间）和 FT（下降时间）中位数均低于 HCC 组，p<0.05。HCC 和非 HCC 恶性肿瘤组的 WiAUC（灌注区曲线下面积）、WoAUC（洗脱区曲线下面积）、WiWoAUC（灌注和洗脱区曲线下面积）和 WoR（洗脱率）值存在统计学差异，p<0.05。使用 LR-M 洗脱时间<60 s 和 FT≤21.2 s 作为新的诊断标准，LR-5 类别对 HCC 的诊断灵敏度为 83.9%，特异性为 96.2%，阳性预测值为 98.3%。
结论
DCE-US 有助于区分 HCC 和非 HCC 恶性肿瘤。非 HCC 恶性肿瘤的峰值增强更早，洗脱更快更明显，与 HCC 结节不同。LR-M 分类标准与 FT≤21.2 s 的结合可以显著提高 LR-5 类别对 HCC 的诊断灵敏度。
Zotero 插件