常规超声结合Valsalva动作与常规超声在肝血管瘤中临床诊断价值比较
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摘要
目的探讨常规超声结合Valsalva动作与常规超声诊断肝血管瘤的临床应用价值。方法选取疑似肝血管瘤患者45例,行常规超声及常规超声结合Valsalva动作筛检试验,比较2种方法的诊断灵敏度、特异度、Kappa值并观察影像表现。结果常规超声诊断灵敏度为86.67%,特异度为80.00%,Kappa值为0.66;常规超声结合Valsalva动作诊断灵敏度为93.33%,特异度为86.67%,Kappa值为0.80;常规超声结合Valsalva动作与金标准检出一致性较高;常规超声和常规超声结合Valsalva动作在对≥3 cm的病灶诊断准确率比较上,差异无统计学意义(P>0.05);而在<3 cm的病灶诊断准确率比较上,常规超声结合Valsalva动作的诊断准确率高于常规超声诊断,差异有统计学意义(P<0.05)。在常规超声结合Valsalva动作发现的28个病灶中:12个病灶回声呈整体增强;16个病灶回声呈部分增强,边缘更清晰;3个病灶表现为后方回声增强。结论常规超声结合Valsalva动作检测方法应用于诊断肝血管瘤与金标准具有较高的一致性。对于<3 cm的病灶诊断,常规超声结合Valsalva动作的准确率高于常规超声诊断,并且常规超声结合Valsalva动作检测方法经济、快捷、无创,其诊断价值有待在临床上进一步地发掘。
Objective The objective of this study was to explore the clinical application value of conventional ultrasound combined with Valsalva maneuver and conventional ultrasound in the diagnosis of hepatic hemangioma. Methods 45 patients with suspected hepatic hemangioma were selected for conventional ultrasound and conventional ultrasound combined with Valsalva maneuver screening test. The diagnostic sensitivity, specificity, Kappa value of the two methods was compared and their imaging manifestations were observed. Results The sensitivity, specificity and Kappa value of conventional ultrasound diagnosis were 86.67%, 80.00% and0.66 respectively. While the sensitivity, specificity and Kappa value of conventional ultrasound combined with Valsalva maneuver in the diagnosis of hepatic hemangioma were 93.33%, 86.67% and 0.80 respectively. Conventional ultrasound combined with Valsalva Maneuver was highly consistent with gold standard; there was no significant difference in the diagnostic accuracy of conventional ultrasound and conventional ultrasound combined with Valsalva maneuver in the diagnosis for lesions ≥3 cm(P>0.05). However, for diagnostic accuracy for lesions <3 cm, the diagnostic accuracy of conventional ultrasound combined with Valsalva maneuver was higher than that of conventional ultrasound, and the difference was statistically significant(P<0.05). In the 28 lesions detected by conventional ultrasound combined with Valsalva maneuver, the echo of 12 lesions was wholly enhanced; the echo of 16 lesions was partially enhanced and the edges were clearer;the echo of 3 lesions manifested as posterior enhancement. Conclusions Conventional ultrasound combined with Valsalva maneuver detection has high consistency with the gold standard in the diagnosis of hepatic hemangioma. For the diagnosis for lesions <3 cm, the accuracy of conventional ultrasound combined with Valsalva maneuver is higher than that of conventional ultrasound, and the conventional ultrasound combined with Valsalva maneuver detection method is economic, rapid and noninvasive.
Objective The objective of this study was to explore the clinical application value of conventional ultrasound combined with Valsalva maneuver and conventional ultrasound in the diagnosis of hepatic hemangioma. Methods 45 patients with suspected hepatic hemangioma were selected for conventional ultrasound and conventional ultrasound combined with Valsalva maneuver screening test. The diagnostic sensitivity, specificity, Kappa value of the two methods was compared and their imaging manifestations were observed. Results The sensitivity, specificity and Kappa value of conventional ultrasound diagnosis were 86.67%, 80.00% and0.66 respectively. While the sensitivity, specificity and Kappa value of conventional ultrasound combined with Valsalva maneuver in the diagnosis of hepatic hemangioma were 93.33%, 86.67% and 0.80 respectively. Conventional ultrasound combined with Valsalva Maneuver was highly consistent with gold standard; there was no significant difference in the diagnostic accuracy of conventional ultrasound and conventional ultrasound combined with Valsalva maneuver in the diagnosis for lesions ≥3 cm(P>0.05). However, for diagnostic accuracy for lesions <3 cm, the diagnostic accuracy of conventional ultrasound combined with Valsalva maneuver was higher than that of conventional ultrasound, and the difference was statistically significant(P<0.05). In the 28 lesions detected by conventional ultrasound combined with Valsalva maneuver, the echo of 12 lesions was wholly enhanced; the echo of 16 lesions was partially enhanced and the edges were clearer;the echo of 3 lesions manifested as posterior enhancement. Conclusions Conventional ultrasound combined with Valsalva maneuver detection has high consistency with the gold standard in the diagnosis of hepatic hemangioma. For the diagnosis for lesions <3 cm, the accuracy of conventional ultrasound combined with Valsalva maneuver is higher than that of conventional ultrasound, and the conventional ultrasound combined with Valsalva maneuver detection method is economic, rapid and noninvasive.
引文
[1] Won H J, Kim P N, Lee J S. Changes in echogenicity of hepatic hemangiomas during the Valsalva maneuver[J]. J Clin Ultrasound, 2017,45(6):328-331.DOI:10.1002/jcu.22456.
[2] Marrero J A, Ahn J, Rajender Reddy K, et al. ACG clinical guideline:the diagnosis and management of focal liver lesions[J]. Am J Gastroenterol, 2014,109(9):1328-1347. DOI:10.1038/ajg.2014.213.
[3]周永昌,郭万学.超声医学[M]. 4版.北京:科学技术文献出版社,2002:927-928.
[4]王晓波,陈忠,邓连桂,等.彩色多普勒超声与磁共振成像检查在肝脏局灶性结节性增生病变诊断中的比较[J].中国当代医药,2018,25(19):125-128.
[5]邓龙,马苏美.复杂肝囊肿超声表现1例[J].临床超声医学杂志,2018,20(12):818.DOI:10.16245/j.cnki.issn1008-6978.2018.12.008.
[6]唐玉德,刘树学,张雄彪,等.肝脏局灶性结节增生的MRI表现及随访观察[J].实用放射学杂志,2015, 31(9):1471-1474. DOI:10.3969/j.issn. 002-1671.2015.09.017.
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[8] Choji K, Shinohara M, Nojima T, et al. Significant reduction of the echogenicity of the compressed cavernous hemangioma[J]. Acta Radiol, 1988,29(3):317-320.DOI:10.1080/02841858809171906.
[9] Okano H, Shiraki K, Inoue H, et al."Variable echo sign"(ultrasonographical alteration of echogenicity)in cavernous hepatichemangioma[J].Int J Oncol,2001,19(2):337-340. DOI:10.3892/ijo.19.2.337.
[10] Ipek-Ugay S, Tzschatzsch H, Braun J, et al. Physiologic reduction of hepatic venous blood flow by the Valsalva maneuver decreases liver stiffness[J].J Ultrasound Med,2017,36(7):1305-1311.DOI:10.7863/ultra.16.07046.
[11] Veluvolu P, Daniels D L, Collier B D, et al. Scintigraphic demonstration of a soft tissue cavernous hemangioma with Valsalva maneuver[J]. Clin Nucl Med, 1990,15(12):865-869. DOI:10.1097/00003072-199012000-00002.
[12] Wilson S R, Winters C E. Diagnostic Ultrasound[M].4th ed. Philadelphia:Elsevier, 2011:78.
[13] Low G, Leen E. Clinical Ultrasound[M]. 3rd ed. New York:Churchill Livingstone, 2011:138.
[14]陈苏,肖萤,廖锦堂,等.肝小血管瘤与Ⅰ型、Ⅲ型非均匀性脂肪肝的超声表现[J].医学临床研究,2007,24(12):2162-2164. DOI:10.3969/j.issn.1671-7171.2007.12.057.
[15]刘洋,邵秋杰.脂肪肝背景下肝血管瘤的超声表现[J].实用医学杂志,2010,26(12):2257-2258. DOI:10.3969/j.issn.1006-5725.2010.12.091.
[16]赵晓燕.肝小血管瘤、非均匀性脂肪肝的超声诊断应用价值及超声鉴别诊断分析[J].中国卫生标准管理,2017,8(16):130-131.DOI:10.3969/j.issn.1674-9316.2017.16.070.
[2] Marrero J A, Ahn J, Rajender Reddy K, et al. ACG clinical guideline:the diagnosis and management of focal liver lesions[J]. Am J Gastroenterol, 2014,109(9):1328-1347. DOI:10.1038/ajg.2014.213.
[3]周永昌,郭万学.超声医学[M]. 4版.北京:科学技术文献出版社,2002:927-928.
[4]王晓波,陈忠,邓连桂,等.彩色多普勒超声与磁共振成像检查在肝脏局灶性结节性增生病变诊断中的比较[J].中国当代医药,2018,25(19):125-128.
[5]邓龙,马苏美.复杂肝囊肿超声表现1例[J].临床超声医学杂志,2018,20(12):818.DOI:10.16245/j.cnki.issn1008-6978.2018.12.008.
[6]唐玉德,刘树学,张雄彪,等.肝脏局灶性结节增生的MRI表现及随访观察[J].实用放射学杂志,2015, 31(9):1471-1474. DOI:10.3969/j.issn. 002-1671.2015.09.017.
[7]耿艳琼.彩色多普勒超声诊断肝血管瘤的效果探究[J].继续医学教育,2018,32(6):135-136. DOI:10.3969/j.issn.1004-6763.2018.06.080.
[8] Choji K, Shinohara M, Nojima T, et al. Significant reduction of the echogenicity of the compressed cavernous hemangioma[J]. Acta Radiol, 1988,29(3):317-320.DOI:10.1080/02841858809171906.
[9] Okano H, Shiraki K, Inoue H, et al."Variable echo sign"(ultrasonographical alteration of echogenicity)in cavernous hepatichemangioma[J].Int J Oncol,2001,19(2):337-340. DOI:10.3892/ijo.19.2.337.
[10] Ipek-Ugay S, Tzschatzsch H, Braun J, et al. Physiologic reduction of hepatic venous blood flow by the Valsalva maneuver decreases liver stiffness[J].J Ultrasound Med,2017,36(7):1305-1311.DOI:10.7863/ultra.16.07046.
[11] Veluvolu P, Daniels D L, Collier B D, et al. Scintigraphic demonstration of a soft tissue cavernous hemangioma with Valsalva maneuver[J]. Clin Nucl Med, 1990,15(12):865-869. DOI:10.1097/00003072-199012000-00002.
[12] Wilson S R, Winters C E. Diagnostic Ultrasound[M].4th ed. Philadelphia:Elsevier, 2011:78.
[13] Low G, Leen E. Clinical Ultrasound[M]. 3rd ed. New York:Churchill Livingstone, 2011:138.
[14]陈苏,肖萤,廖锦堂,等.肝小血管瘤与Ⅰ型、Ⅲ型非均匀性脂肪肝的超声表现[J].医学临床研究,2007,24(12):2162-2164. DOI:10.3969/j.issn.1671-7171.2007.12.057.
[15]刘洋,邵秋杰.脂肪肝背景下肝血管瘤的超声表现[J].实用医学杂志,2010,26(12):2257-2258. DOI:10.3969/j.issn.1006-5725.2010.12.091.
[16]赵晓燕.肝小血管瘤、非均匀性脂肪肝的超声诊断应用价值及超声鉴别诊断分析[J].中国卫生标准管理,2017,8(16):130-131.DOI:10.3969/j.issn.1674-9316.2017.16.070.