超声造影对小肝癌的诊断及临床应用价值研究
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摘要
目的:探讨超声造影对小肝癌(SHCC)的诊断及临床价值。方法:收集肝硬化合并小肝癌患者76例,选择日立二郎神(HITACHI Hi Vision Preirus)彩色多普勒超声诊断仪对病灶进行超声造影诊断。观察不同分化程度癌超声造影时间分析、增强CT与超声造影诊断率比较、造影前后超声诊断评分比较、小肝癌病灶造影消退时间与病灶大小的相关关系。结果:(1)高分化癌与中-低分化癌在开始增强时间、增强峰值时间方面比较差异均无统计学意义(P>0.05),高分化癌开始消退时间显著高于中-低分化癌(P<0.05);(2)运用增强CT检查的患者,诊断正确的有62例,诊断准确率为81.58%(62/76);运用超声造影检查的患者,诊断正确的有71例,诊断准确率为93.42%(71/76),增强CT检查诊断准确率显著低于超声造影诊断准确率(P<0.05);(3)76例患者造影后超声评分状况显著优于超声造影前(P<0.05);(4)经相关性分析,最终得出小肝癌病灶造影消退时间与病灶大小之间的相关关系为:y=-19.028x+412.9(R~2=0.8445,P<0.01),超声造影剂消退时间与病灶大小之间呈负相关关系;(5)76例小肝癌患者中,18例(23.68%)是基于无目标超声造影检查过程中,于门脉期扫查发现低回声区者,且再次经肝超声造影之后最终确诊,其中17例患者经常规超声检查呈等回声区,1例为弱回声区。结论:超声造影在肝硬化合并小肝癌中的早期诊断准确率较高,具有较高的临床应用价值。
Objective:To investigate the diagnosis and clinical value of ultrasonography in SHCC.Methods:collected in June 2013 to June 2017 treated at our hospital during the period of the clinical data of 76 patients with SHCC,choose HITACHI Hi Vision Preirus color doppler ultrasonic diagnostic apparatus for ultrasonic imaging in the diagnosis of lesions.Observe the degree of differentiation of carcinoma ultrasonic imaging time analysis,enhanced CT and ultrasound imaging diagnostic rate comparison,contrast ultrasound diagnostic score before and after comparison,SHCC lesions imaging time relation with the size of the lesions.Results:(1)High differentiation carcinoma with medium-low differentiated carcinoma at the beginning of time,enhance the peak time differences had no statistical significance(P>0.05),significantly higher than that in high differentiation carcinoma began to fade timepoorly differentiated carcinoma(P<0.05);(2)patients with enhanced CT scan were diagnosed correctly with 62 cases,with a diagnosis accuracy of 81.58%(62/76);The diagnostic accuracy was 93.42%(71/76),with 71 cases diagnosed with ultrasonography.The diagnostic accuracy of enhanced CT examination was significantly lower than that of ultrasonography(P<0.05).(3)The ultrasonography score of 76 patients in this group was significantly better than that of the ultrasonography(P<0.05).(4)The correlation analysis,and finally concludes that SHCC lesions imaging fading away and the correlation between the lesion size:y=19.028+412.9 x(R~2=0.8445,P<0.01),i.e.,ultrasound contrast agent fade lesions showed a negative correlation relationship between size and time;(5)In this study,76 patients with small hepatocellular carcinoma in 18 cases(23.68%)was based on the goal in the process of ultrasonic imaging examination,found keyed in portal phase scanning acoustic area,and again after liver ultrasound angiography confirmed finally,17 patients by routine ultrasound examination was hypoechoic area,1 case of weak echo region.Conclusion:Ultrasonography has high diagnostic accuracy and high clinical value in liver cirrhosis combined with SHCC.
Objective:To investigate the diagnosis and clinical value of ultrasonography in SHCC.Methods:collected in June 2013 to June 2017 treated at our hospital during the period of the clinical data of 76 patients with SHCC,choose HITACHI Hi Vision Preirus color doppler ultrasonic diagnostic apparatus for ultrasonic imaging in the diagnosis of lesions.Observe the degree of differentiation of carcinoma ultrasonic imaging time analysis,enhanced CT and ultrasound imaging diagnostic rate comparison,contrast ultrasound diagnostic score before and after comparison,SHCC lesions imaging time relation with the size of the lesions.Results:(1)High differentiation carcinoma with medium-low differentiated carcinoma at the beginning of time,enhance the peak time differences had no statistical significance(P>0.05),significantly higher than that in high differentiation carcinoma began to fade timepoorly differentiated carcinoma(P<0.05);(2)patients with enhanced CT scan were diagnosed correctly with 62 cases,with a diagnosis accuracy of 81.58%(62/76);The diagnostic accuracy was 93.42%(71/76),with 71 cases diagnosed with ultrasonography.The diagnostic accuracy of enhanced CT examination was significantly lower than that of ultrasonography(P<0.05).(3)The ultrasonography score of 76 patients in this group was significantly better than that of the ultrasonography(P<0.05).(4)The correlation analysis,and finally concludes that SHCC lesions imaging fading away and the correlation between the lesion size:y=19.028+412.9 x(R~2=0.8445,P<0.01),i.e.,ultrasound contrast agent fade lesions showed a negative correlation relationship between size and time;(5)In this study,76 patients with small hepatocellular carcinoma in 18 cases(23.68%)was based on the goal in the process of ultrasonic imaging examination,found keyed in portal phase scanning acoustic area,and again after liver ultrasound angiography confirmed finally,17 patients by routine ultrasound examination was hypoechoic area,1 case of weak echo region.Conclusion:Ultrasonography has high diagnostic accuracy and high clinical value in liver cirrhosis combined with SHCC.
引文
[1]齐元富,李慧杰,李静.六神丸对H22肝癌腹水移植瘤PDGF与VEGF表达的影响及相关机制探讨[J].世界中医药,2013,8(1):69-71.
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[6]徐金锋,吴瑛,佘志红,等.彩色多普勒能量图对小肝癌与肝腺瘤样增生结节的鉴别诊断研究[J].中华超声影像学杂志,2012,33(1):256-257.
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[9]刘广健,王伟,吕明德,等.Sonazoid超声造影诊断肝纤维化或肝硬化的实验研究[J].中华超声影像学杂志,2011,20(8):711-715.
[10]贾春梅,李廷廷,康春松,等.肝硬化结节与小肝癌实时超声造影定量比较研究[J].中华超声影像学杂志,2013,22(2):123-126.
[11]邓晶,胡建群,林红军,等.肝脏局灶性结节增生的超声造影诊断[J].南京医科大学学报:自然科学版,2011,18(5):222-224.
[12]曾文,郑晨.Treg、TH17相关细胞因子与原发性肝癌预后的关系[J].陕西医学杂志,2014,43(10):1290-1291,1295.
[2]施纯朝,薛峰,孙延富,等.乙型肝炎肝硬化并发原发性肝癌的危险因素[J].实用癌症杂志,2013,28(4):399-401.
[3]曾鸽,张生光,俞静,等.超声造影在腹部实质性脏器损伤中的诊断价值[J].中国实用医刊,2013,40(19):96-97.
[4]张继红.超声造影对肝硬化患者良恶性结节的鉴别诊断价值研究[J].实用癌症杂志,2014,29(9):1140-1142.
[5]江昊,陈靖,江家骥,等.超声造影在肝硬化背景下对小肝癌诊断价值的Meta分析[J].中华肝脏病杂志,2012,20(11):828-832.
[6]徐金锋,吴瑛,佘志红,等.彩色多普勒能量图对小肝癌与肝腺瘤样增生结节的鉴别诊断研究[J].中华超声影像学杂志,2012,33(1):256-257.
[7]Holstein A,Hinze S,Thiessen E.Clinical implications of hepatogenous diabetes in liver cirrhosis[J].Journal of Gastroenterology and Hepatology,2012,10(1):677-681.
[8]王柯懿,袁友红.大鼠肝硬化肝癌模型磁共振扩散成像动态ADC值量化研究[J].湖南师范大学学报:医学版,2013,37(10):620-621.
[9]刘广健,王伟,吕明德,等.Sonazoid超声造影诊断肝纤维化或肝硬化的实验研究[J].中华超声影像学杂志,2011,20(8):711-715.
[10]贾春梅,李廷廷,康春松,等.肝硬化结节与小肝癌实时超声造影定量比较研究[J].中华超声影像学杂志,2013,22(2):123-126.
[11]邓晶,胡建群,林红军,等.肝脏局灶性结节增生的超声造影诊断[J].南京医科大学学报:自然科学版,2011,18(5):222-224.
[12]曾文,郑晨.Treg、TH17相关细胞因子与原发性肝癌预后的关系[J].陕西医学杂志,2014,43(10):1290-1291,1295.