Department of Diagnostic Imaging, St. Jude Children's Research Hospital MS 220, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
Department of Diagnostic Imaging, Cairo University, Cairo, Egypt.
Cancer Imaging. 2024 Aug 29;24(1):115. doi: 10.1186/s40644-024-00750-3.
Patients treated for cancer have a higher incidence of focal liver lesions than the general population and there is often concern for a malignant etiology. This can result in patient, caregiver and physician anxiety and is managed by a "wait and watch" approach, or immediate additional imaging, or biopsy, depending on the degree of clinical concern. Because it is a low-cost, easily accessible, radiation and sedation free modality, we investigated the value of contrast enhanced ultrasound (CEUS) to accurately distinguish benign from malignant liver lesions in patients treated for childhood malignancies.
We performed an IRB approved retrospective study of 68 subjects who were newly diagnosed, on treatment or off treatment for a pediatric malignancy and had liver lesions discovered on CT, MRI or non-contrast ultrasound and subsequently underwent CEUS between September 2013 and September 2021. Two experienced pediatric radiologists and a radiology trainee, blinded to the etiology of the liver lesions, independently reviewed the CEUS examinations and categorized lesions as benign, indeterminate, or malignant. The reference standard was biopsy for 19 lesions and clinical follow-up for 49. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of CEUS were calculated using only the benign and malignant CEUS classifications. Inter-reviewer agreement was assessed by Cohen's kappa statistic.
There were 26 males and 42 females, mean age, 14.9 years (range, 1-52 years). Fifty subjects were off therapy, twelve receiving treatment, and six with newly diagnosed cancer. By the reference standard, 59 (87%) lesions were benign and 9 (13%) were malignant. Sensitivities of CEUS for the three reviewers ranged from 83 to 100% (95% CI, 35.9-100%), specificities from 93.1 to 96.0% (95% CI, 83.5-99.6%), PPV 60.0-71.4% (95% CI, 29.0-96.3%), NPV 98.0-100% (95% CI, 89.2-100%) and accuracy from 93.8 to 94.6% (95% CI, 85.1-99.7%). The kappa statistic for agreement between the two experienced radiologists was moderate at 0.58.
CEUS is highly accurate in distinguishing benign from malignant etiologies of liver lesions in patients treated for pediatric malignancies.
与一般人群相比，接受癌症治疗的患者发生局灶性肝病变的发生率更高，且常担心其为恶性病因。这可能导致患者、护理人员和医生产生焦虑，并通过“等待和观察”的方法、立即进行额外的影像学检查或活检来进行管理，具体取决于临床关注的程度。由于增强超声（CEUS）是一种低成本、易于获取、无辐射和镇静的方法，我们研究了其在鉴别儿童恶性肿瘤治疗后患者的良性和恶性肝病变方面的价值。
我们对 2013 年 9 月至 2021 年 9 月期间新诊断为儿童恶性肿瘤、治疗中或治疗后、在 CT、MRI 或非对比超声上发现肝病变的 68 例患者进行了一项经机构审查委员会批准的回顾性研究，这些患者随后接受了 CEUS 检查。两名经验丰富的儿科放射科医生和一名放射科住院医师在不知道肝病变病因的情况下，对 CEUS 检查结果进行了独立评估，并将病变分为良性、不确定或恶性。参考标准为 19 个病变的活检和 49 个病变的临床随访。仅使用良性和恶性 CEUS 分类计算 CEUS 的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性。采用 Cohen's kappa 统计评估复查者间的一致性。
68 例患者中，男性 26 例，女性 42 例，平均年龄 14.9 岁（范围 1-52 岁）。50 例患者已停药，12 例正在接受治疗，6 例为新诊断的癌症患者。根据参考标准，59 个（87%）病变为良性，9 个（13%）为恶性。三名复查者的 CEUS 敏感性范围为 83%至 100%（95%可信区间为 35.9%-100%），特异性范围为 93.1%至 96.0%（95%可信区间为 83.5%-99.6%），阳性预测值为 60.0%-71.4%（95%可信区间为 29.0%-96.3%），阴性预测值为 98.0%-100%（95%可信区间为 89.2%-100%），准确性为 93.8%-94.6%（95%可信区间为 85.1%-99.7%）。两名经验丰富的放射科医生之间的κ统计量为中度，为 0.58。
CEUS 高度准确地区分了儿童恶性肿瘤治疗后患者肝病变的良性和恶性病因。
