声速匹配技术鉴别原发性肝癌与肝血管瘤的应用价值研究
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摘要
背景原发性肝癌为致死率高的肝脏恶性肿瘤,肝血管瘤为最常见的肝脏良性肿瘤,而常规超声检查的灵敏度和特异度较低,超声造影操作复杂且有创,因此探寻新型的检查方法是大势所趋。目的探讨声速匹配(SSC)技术在原发性肝癌与肝血管瘤鉴别诊断中的应用价值。方法选取2016年11月—2017年11月就诊于华北理工大学附属医院的符合研究标准的肝脏实性肿物患者85例,肿物92个(原发性肝癌44个、肝血管瘤48个)。依据穿刺或手术病理结果将患者分为原发性肝癌组(n=39)和肝血管瘤组(n=46)。患者均进行SSC检查,分析肝脏肿物的区域速度指数(ZSI)值鉴别诊断原发性肝癌与肝血管瘤的价值。结果原发性肝癌组44个肿物的ZSI值为(43.0±7.4)m/s,肝血管瘤组48个肿物的ZSI值为(22.3±7.4)m/s;原发性肝癌组肿物的ZSI值高于肝血管瘤组(t=13.303,P<0.001)。绘制ZSI值诊断原发性肝癌的ROC曲线,当ZSI=33 m/s时,ZSI值诊断原发性肝癌的ROC曲线下面积为0.987(>0.700),灵敏度为97.7%,特异度为91.7%,约登指数为0.894。结论当ZSI=33 m/s时,SSC鉴别诊断原发性肝癌与肝血管瘤的灵敏度、特异度均较高,可为超声鉴别原发性肝癌与肝血管瘤提供新的量化诊断参考指标。
Background Primary liver cancer(PLC) is a malignant tumor with high mortality.Hepatic hemangioma(HH) is the most common benign tumor of liver.As the sensitivity and specificity of conventional ultrasound are low,and the contrast-enhanced ultrasound is invasive and its operation is complex,better examination methods for differentiating between PLC and HH are urgently needed.Objective To discuss the application of sound speed correction(SSC) technique in the differential diagnosis of PLC from HH.Methods We enrolled 85 eligible patients with solid liver masses(totaled 92 masses)from North China University of Science and Technology Affiliated Hospital from November 2016 to November 2017.According to the pathological results of the biopsy tissue or surgical specimen,39(totaled 44 masses were identified to be PLC) were assigned to the PLC group and 46(totaled 48 masses were identified to be HH) were assigned to the HH group,respectively.All of them underwent color Doppler ultrasound for the determination of the zone speed index(ZSI) of the ROI with SSC technique(for enhancing the quality of the images).Results The ZSI value of the masses of the PLC group was greater than that of the masses of the HH group〔(43.0±7.4)m/s vs(22.3±7.4)m/s〕(t=13.303,P<0.001).For the diagnosis of PLC,the AUC of ZSI was 0.987(>0.700)when the cutoff value was 33 m/s,the corresponding sensitivity was 97.7%,specificity was 91.7%,and Youden's index was 0.894.Conclusion When the ZSI value is 33 m/s(determined by the color Doppler ultrasound examination with SSC technique),both the sensitivity and specificity of its performance for differential diagnosis of PLC from HH are high,providing a reference for quantitatively differentiating between the two diseases.
Background Primary liver cancer(PLC) is a malignant tumor with high mortality.Hepatic hemangioma(HH) is the most common benign tumor of liver.As the sensitivity and specificity of conventional ultrasound are low,and the contrast-enhanced ultrasound is invasive and its operation is complex,better examination methods for differentiating between PLC and HH are urgently needed.Objective To discuss the application of sound speed correction(SSC) technique in the differential diagnosis of PLC from HH.Methods We enrolled 85 eligible patients with solid liver masses(totaled 92 masses)from North China University of Science and Technology Affiliated Hospital from November 2016 to November 2017.According to the pathological results of the biopsy tissue or surgical specimen,39(totaled 44 masses were identified to be PLC) were assigned to the PLC group and 46(totaled 48 masses were identified to be HH) were assigned to the HH group,respectively.All of them underwent color Doppler ultrasound for the determination of the zone speed index(ZSI) of the ROI with SSC technique(for enhancing the quality of the images).Results The ZSI value of the masses of the PLC group was greater than that of the masses of the HH group〔(43.0±7.4)m/s vs(22.3±7.4)m/s〕(t=13.303,P<0.001).For the diagnosis of PLC,the AUC of ZSI was 0.987(>0.700)when the cutoff value was 33 m/s,the corresponding sensitivity was 97.7%,specificity was 91.7%,and Youden's index was 0.894.Conclusion When the ZSI value is 33 m/s(determined by the color Doppler ultrasound examination with SSC technique),both the sensitivity and specificity of its performance for differential diagnosis of PLC from HH are high,providing a reference for quantitatively differentiating between the two diseases.
引文
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[8]董常峰,刘映霞,李汉英,等.声速匹配与声触诊组织量化技术对比评价肝纤维化及早期肝硬化的研究[J].中国超声医学杂志,2013,29(7):619-622.DOI:10.3969/j.issn.1002-0101.2013.07.015.DONG C F,LIU Y X,LI H Y,et al.Prospective study of sound speed correction and virtual touch tissue quantification for hepatic fibrosis and early stage cirrhosis[J].Chinese J Ultrasound Med,2013,29(7):619-622.DOI:10.3969/j.issn.1002-0101.2013.07.015.
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[10]BARR R G.Speed of sound correction and quality control[J].J U l t r a s o u n d M e d,2 0 1 2,3 1(9):1 4 7 1.D O I:10.7863/jum.2012.31.9.1471.
[11]BOOZARI B,POTTHOFF A,MEDERACKE I,et al.Evaluation of sound speed for detection of liver fibrosis:prospective comparison with transient dynamic elastography and histology[J].J Ultrasound Med,2010,29(11):1581-1588.DOI:10.7863/jum.2010.29.11.1581.
[12]PASZEK M J,WEAVER V M.The tension mounts:mechanics meets morphogenesis and malignancy[J].J Mammary Gland Biol Neoplasia,2004,9(4):325-342.DOI:10.1007/s10911-004-1404-x.
[13]温玉良,马琳,阚艳敏,等.声速匹配技术在乳腺良恶性病灶鉴别诊断中的价值初探[J].临床超声医学杂志,2014,16(7):451-453.WEN Y L,MA L,KAN Y M,et al.Study on the differential diagnosis of benign and malignant breast masses using sound speed correction technique[J].Journal of Clinical Ultrasound in Medicine,2014,16(7):451-453.
[14]欧冰,智慧,吴嘉仪,等.声速测算对乳腺肿物诊断价值的初探[J].中国超声医学杂志,2013,29(5):422-424.DOI:10.3969/j.issn.1002-0101.2013.05.014.OU B,ZHI H,WU J Y,et al.Primary evaluation of sound velocity in differentiating benign or malignant of breast lesions[J].Chinese Journal of Ultrasound in Medicine,2013,29(5):422-424.DOI:10.3969/j.issn.1002-0101.2013.05.014.
[15]冯华梅,马琳,阚艳敏,等.声速匹配技术在原发性甲亢诊断中的应用[J].医学影像学杂志,2014,24(2):293-295.FENG H M,MA L,KAN Y M,et al.The application value of velocity matching techniques in the diagnosis of graves disease[J].Journal of Medical Imaging,2014,24(2):293-295.
[16]中国抗癌协会肝癌专业委员会,中国抗癌协会临床肿瘤学协作专业委员会,中华医学会肝病学会肝癌学组,等.原发性肝癌规范化病理诊断方案专家共识[J].实用肝脏病杂志,2011,14(3):161-163.DOI:10.3969/j.issn.1672-5069.2011.03.001.
[17]吴刚,王绮,杨龙,等.定量声辐射脉冲弹性成像技术评价肝肿瘤特性的初步研究[J].中华超声影像学杂志,2011,20(3):226-229.DOI:10.3760/cma.j.issn.1004-4477.2011.03.015.
[18]FRANCO D,USATOFF V.Surgery for cholangiocarcinoma[J].Hepatogastroenterology,2001,48(37):53-55.DOI:10.1007/978-1-4615-0547-1_7.
[19]崔彦,董家鸿.肝血管瘤的病理和临床特点及微创治疗[J].中国微创外科杂志,2006,6(5):338-340.DOI:10.3969/j.issn.1009-6604.2006.05.010.
[20]付度关,尹家宝,周素芬,等.超声造影区分肝硬化患者肝细胞性肝癌和肝血管瘤[J].湖北医药学院学报,2012,31(5):395-398.
[21]VIGRAIN V,UZAN F,BRANCATELLI G,et al.Prevalence of hepatic hemangioma in patients with focal nodular hyperplasia:MRimaging analysis[J].Radiology,2003,229(1):75-79.DOI:10.1148/radiol.2291021284.
[22]LUO W,NUMATA K,MORIMOTO M,et al.Three-dimensional contrast-enhanced sonography of vascular patterns of focal liver tumors:pilot study of visualization methods[J].AJR Am JRoentgenol,2009,192(1):165-173.
[23]SIRLI R,SPOREA I,POPESCU A,et al.Contrast enhanced ultrasound for the diagnosis of liver hemangiomas in clinical practice[J].Med Ultrason,2011,13(2):95-101.
[24]刘丹,杨松青,张钧.原发性肝癌超声造影诊断价值探讨[J].中华肿瘤防治杂志,2014,21(9):698-700.DOI:10.16073/j.cnki.cjcpt.2014.09.013.LIU D,YANG S Q,ZHANG J.Diagnostic value of contrastenhenced ultrasound in primary liver carcinoma[J].Chinese Journal of Cancer Prevention and Treatment,2014,21(9):165-173.DOI:10.16073/j.cnki.cjcpt.2014.09.013.2018032620180524
[2]JEMAL A,BRAY F,CENTER M M,et al.Global cancer statistics[J].CA Cancer J Clin,2011,61(2):69-90.DOI:10.3322/caac.20107.
[3]JHAVERI K S,VLACHOU P A,GUINDI M,et al.Association of hepatic hemangiomatosis with giant cavernous hemangioma in the adult population:prevalence,imaging appearance,and relevance[J].AJR Am J Roentgenol,2011,196(4):809-815.DOI:10.2214/AJR.09.4143.
[4]周雯,黄嵘,戚玉龙,等.MRI MOCO技术在肝脏局灶性病变诊断中的应用[J].中国CT和MRI杂志,2013,11(2):31-34.DOI:10.3969/j.issn.1672-5131.2013.02.011.ZHOU W,HUANG R,QI Y L,et al.Application of MOCOtechnology in diagnosis of focal liver lesions[J].Chinese Journal of CT and MRI,2013,11(2):31-34.DOI:10.3969/j.issn.1672-5131.2013.02.011.
[5]NSPOLITANO D,CHOU C H,MCLAUGHLIN G,et al.Sound speed correction in ultrasound imaging[J].Ultrasonics,2006,22(44Suppl 1):e43-46.
[6]余珊珊,姜珏,李小鹏,等.声速匹配技术对儿童及青少年脂肪肝诊断价值的初探[J].中国超声医学杂志,2014,30(6):528-531.YU S S,JIANG Y,LI X P,et al.Preliminary investigation on diagnostic value of sound velocity matching technology for fatty liver in children and adolescents[J].Chinese Journal of Ultrasound in Medicine,2014,30(6):528-531.
[7]刘颖,马琳,阚艳敏,等.脂肪肝患者肝组织声速匹配值变化及意义[J].山东医药,2014,54(15):85-86.DOI:10.3969/j.issn.1002-266X.2014.15.033.
[8]董常峰,刘映霞,李汉英,等.声速匹配与声触诊组织量化技术对比评价肝纤维化及早期肝硬化的研究[J].中国超声医学杂志,2013,29(7):619-622.DOI:10.3969/j.issn.1002-0101.2013.07.015.DONG C F,LIU Y X,LI H Y,et al.Prospective study of sound speed correction and virtual touch tissue quantification for hepatic fibrosis and early stage cirrhosis[J].Chinese J Ultrasound Med,2013,29(7):619-622.DOI:10.3969/j.issn.1002-0101.2013.07.015.
[9]周淑香,王建华.正常人肝脏区域速度指数的检测方法和影响因素的初步研究[J].中华超声影像学杂志,2013,22(2):127-129.DOI:10.3760/cma.j.issn.1004-4477.2013.02.011.ZHOU S X,WANG J H.A preliminary study on methods and influencing factors of liver zone speed index in healthy subjects[J].Chinese Journal of Ultrasonography,2013,22(2):127-129.DOI:10.3760/cma.j.issn.1004-4477.2013.02.011.
[10]BARR R G.Speed of sound correction and quality control[J].J U l t r a s o u n d M e d,2 0 1 2,3 1(9):1 4 7 1.D O I:10.7863/jum.2012.31.9.1471.
[11]BOOZARI B,POTTHOFF A,MEDERACKE I,et al.Evaluation of sound speed for detection of liver fibrosis:prospective comparison with transient dynamic elastography and histology[J].J Ultrasound Med,2010,29(11):1581-1588.DOI:10.7863/jum.2010.29.11.1581.
[12]PASZEK M J,WEAVER V M.The tension mounts:mechanics meets morphogenesis and malignancy[J].J Mammary Gland Biol Neoplasia,2004,9(4):325-342.DOI:10.1007/s10911-004-1404-x.
[13]温玉良,马琳,阚艳敏,等.声速匹配技术在乳腺良恶性病灶鉴别诊断中的价值初探[J].临床超声医学杂志,2014,16(7):451-453.WEN Y L,MA L,KAN Y M,et al.Study on the differential diagnosis of benign and malignant breast masses using sound speed correction technique[J].Journal of Clinical Ultrasound in Medicine,2014,16(7):451-453.
[14]欧冰,智慧,吴嘉仪,等.声速测算对乳腺肿物诊断价值的初探[J].中国超声医学杂志,2013,29(5):422-424.DOI:10.3969/j.issn.1002-0101.2013.05.014.OU B,ZHI H,WU J Y,et al.Primary evaluation of sound velocity in differentiating benign or malignant of breast lesions[J].Chinese Journal of Ultrasound in Medicine,2013,29(5):422-424.DOI:10.3969/j.issn.1002-0101.2013.05.014.
[15]冯华梅,马琳,阚艳敏,等.声速匹配技术在原发性甲亢诊断中的应用[J].医学影像学杂志,2014,24(2):293-295.FENG H M,MA L,KAN Y M,et al.The application value of velocity matching techniques in the diagnosis of graves disease[J].Journal of Medical Imaging,2014,24(2):293-295.
[16]中国抗癌协会肝癌专业委员会,中国抗癌协会临床肿瘤学协作专业委员会,中华医学会肝病学会肝癌学组,等.原发性肝癌规范化病理诊断方案专家共识[J].实用肝脏病杂志,2011,14(3):161-163.DOI:10.3969/j.issn.1672-5069.2011.03.001.
[17]吴刚,王绮,杨龙,等.定量声辐射脉冲弹性成像技术评价肝肿瘤特性的初步研究[J].中华超声影像学杂志,2011,20(3):226-229.DOI:10.3760/cma.j.issn.1004-4477.2011.03.015.
[18]FRANCO D,USATOFF V.Surgery for cholangiocarcinoma[J].Hepatogastroenterology,2001,48(37):53-55.DOI:10.1007/978-1-4615-0547-1_7.
[19]崔彦,董家鸿.肝血管瘤的病理和临床特点及微创治疗[J].中国微创外科杂志,2006,6(5):338-340.DOI:10.3969/j.issn.1009-6604.2006.05.010.
[20]付度关,尹家宝,周素芬,等.超声造影区分肝硬化患者肝细胞性肝癌和肝血管瘤[J].湖北医药学院学报,2012,31(5):395-398.
[21]VIGRAIN V,UZAN F,BRANCATELLI G,et al.Prevalence of hepatic hemangioma in patients with focal nodular hyperplasia:MRimaging analysis[J].Radiology,2003,229(1):75-79.DOI:10.1148/radiol.2291021284.
[22]LUO W,NUMATA K,MORIMOTO M,et al.Three-dimensional contrast-enhanced sonography of vascular patterns of focal liver tumors:pilot study of visualization methods[J].AJR Am JRoentgenol,2009,192(1):165-173.
[23]SIRLI R,SPOREA I,POPESCU A,et al.Contrast enhanced ultrasound for the diagnosis of liver hemangiomas in clinical practice[J].Med Ultrason,2011,13(2):95-101.
[24]刘丹,杨松青,张钧.原发性肝癌超声造影诊断价值探讨[J].中华肿瘤防治杂志,2014,21(9):698-700.DOI:10.16073/j.cnki.cjcpt.2014.09.013.LIU D,YANG S Q,ZHANG J.Diagnostic value of contrastenhenced ultrasound in primary liver carcinoma[J].Chinese Journal of Cancer Prevention and Treatment,2014,21(9):165-173.DOI:10.16073/j.cnki.cjcpt.2014.09.013.2018032620180524