天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (6): 643-647.doi: 10.11958/20170410

• 诊断技术与方法 • 上一篇    下一篇

超声造影与增强螺旋 CT 诊断肝细胞癌的对比研究

时静祥，王毅军，经翔，王凤梅，丁建民，张翔，张勤   

  1. 天津市第三中心医院，天津市人工细胞重点实验室，天津市肝胆疾病研究所，卫生部人工细胞工程技术研究中心（邮编 300170）
  • 收稿日期:2017-04-05 修回日期:2017-04-17 出版日期:2017-06-15 发布日期:2017-07-05
  • 作者简介:时静祥（1982），男，主治医师，博士，主要从事肝癌诊断和治疗的研究
  • 基金资助:
    天津市卫生局科技基金项目（2013KY03，2014KR04）

Comparison of contrast-enhanced ultrasound and contrast-enhanced helical computed tomography in diagnosis of hepatocellular carcinoma

SHI Jing-xiang, WANG Yi-jun, JING Xiang, WANG Feng-mei, DING Jian-min, ZHANG Xiang, ZHANG Qin   

  1. Tianjin Third Central Hospital, Key Laboratory of Artificial Cell, Institute of Hepatobiliary Disease, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
  • Received:2017-04-05 Revised:2017-04-17 Published:2017-06-15 Online:2017-07-05

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摘要： 目的 比较超声造影（CEUS）与增强螺旋 CT（CECT）对肝硬化背景下肝细胞癌（HCC）的诊断效能。方 法 对 207 例 241 个乙肝肝硬化背景下肝脏局灶性病变进行 CEUS 和 CECT 检查，以病理结果为“金标准”，将两种 检查方法的诊断结果与病理结果进行对比，诊断差异性评价采用 McNemar 检验，一致性评价采用 Kappa 检验。结 果 （1）病理结果显示，113 个≤2 cm 的病灶中，HCC 病灶 63 个，良性病变 50 个。CEUS、CECT 对比“金标准” McNemar 检验的差别均无统计学意义（P 分别为 0.824、0.082），Kappa 检验 CEUS、CECT 与“金标准”结果一致性一般 （Kappa 值分别为 0.643、0.421）；CEUS 诊断 HCC 的敏感度、特异度、阳性预测值、阴性预测值和准确度均高于 CECT。在显示动脉期血供方面，CEUS 增强显示率高于 CECT［87.30%（55/63）vs. 69.84%（44/63），χ2 = 5.704，P = 0.017］。（2）病理结果显示，128 个＞2 cm 的病灶中，HCC 病灶 77 个，良性病变 51 个。CEUS、CECT 对比“金标准” McNemar 检验的差别均无统计学意义（P 分别为 0.481、0.167），Kappa 检验 CEUS、CECT 与“金标准”结果一致性一般 （Kappa 值分别为 0.710、0.697）；两者诊断 HCC 的敏感度、特异度、阳性预测值、阴性预测值和准确度差异不大。在 显示动脉期血供方面，CEUS 增强显示率与 CECT 差异无统计学意义［89.61%（69/77）vs. 85.71%（66/77），χ2 = 0.540， P = 0.462］。结论 对于直径≤2 cm 的 HCC，CEUS 诊断的效果优于 CECT；对于直径＞2 cm 的 HCC 而言，两者的诊 断能力是相似的。

关键词: 癌, 肝细胞, 肝硬化, 超声造影, 增强螺旋 CT

Abstract: Objective To compare the diagnostic value of contrast- enhanced ultrasound (CEUS) and contrastenhanced helical computed tomography (CECT) for hepatocellular carcinoma (HCC) with liver cirrhosis. Methods Two hundreds and forty-one focal liver lesions in 207 patients with Hepatitis B virus (HBV) cirrhosis were detected with CEUS and CECT, respectively. Pathological results were used as "gold standard" to compare the two methods. Diagnostic results of the two methods were compared with pathological results. Differences were assessed using the McNemar test, and the Kappa test was used for consistency evaluation. Results (1) For 113 liver lesions that were ≤ 2 cm, the number of HCC lesions was 63, and the number of benign lesions was 50. There were no significant differences in results of CEUS and CECT compared with that of the "gold standard" of McNemar test results (P = 0.824, P = 0.082). Consistency of the Kappa test results of CEUS and CECT in comparison with the "gold standard" was general (Kappa = 0.643, Kappa = 0.421). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HCC diagnosed by CEUS were higher than those of CECT. The rate of arterial enhancement was better for CEUS [87.30% (55/63)] than that for CECT [69.84% (44/63), χ2 = 5.704, P = 0.017]. (2) For 128 liver lesions that were > 2 cm, the number of HCC lesions was 77, and the number of benign lesions was 51. There were no significant differences in the diagnostic results between McNemar test and CEUS and CECT tests (P = 0.481, P = 0.167). Consistency of the Kappa test results of CEUS and CECT and "gold standard" was general (Kappa = 0.710, Kappa = 0.697). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HCC were not different between two diagnostic methods. The rate of arterial enhancement was 89.61% (69/77) for CEUS and 85.71% (66/77) for CECT, and there was no significant difference between the two groups (χ2 = 0.540, P = 0.462). Conclusion For HCC ≤ 2 cm, the diagnostic performance of CEUS is better than that of CECT. For HCC > 2 cm, the diagnostic performance is similar for the two diagnostic methods.

Key words: carcinoma, hepatocellular, liver cirrhosis, contrast-enhanced ultrasound, contrast-enhanced helical CT