超声造影检查与多期动态增强CT对乙肝肝炎合并原发性肝癌患者的诊断价值对比
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摘要
目的探讨超声造影检查与多期动态增强CT对乙肝肝炎合并原发性肝癌患者的诊断价值。方法回顾分析2015年5月至2018年5月于我院就诊治疗的56例乙肝肝炎合并原发性肝癌患者的资料,且以病理学检查结果为金标准,比较不同检查方法对原发性肝癌的诊断率,总结原发性肝癌的影像学表现。结果多期动态增强CT诊断原发性肝癌的符合率(92.86%)、灵敏度(96.43%)和特异度(89.29%)均显著高于超声造影符合率(71.43%)、灵敏度(75.00%)和特异度(57.14%)(P<0.05)。超声造影有82个病灶在动脉期呈现高增强,门静脉期和延迟期有48个病灶表现为低增强。多期动态增强CT中,其中58个病灶表现为包膜边缘光滑,以明显环形强化表现,另18个病灶以不完整强化的模糊边缘包膜表现。所有病灶均表现为在动脉期高密度明显强化,门脉期强化密度减低,延迟期强化褪去的快进快出模式。结论多期动态增强CT诊断乙型肝炎原发性肝癌诊断符合率较超声造影更高,可更为清晰的显示癌灶类型、大小及位置等,更有利于临床诊断和指导治疗。
Objective To compare the diagnostic value of contrast-enhanced ultrasonography and multi-phase dynamic contrast-enhanced CT in patients with hepatitis B combined with primary liver cancer. Methods The data of 56 patients with hepatitis B and primary liver cancer who were treated in our hospital from May 2015 to May 2018 were retrospectively analyzed.The pathological examination results were used as the gold standard to compare the diagnostic rates of different examination methods for primary liver cancer, and to summarize the imaging findings of primary liver cancer. Results The coincidence rate(92.86%), sensitivity(96.43%) and specificity(89.29%) of multi-phase dynamic contrast-enhanced CT in the diagnosis of primary liver cancer were significantly higher than the coincidence rate(71.43%), sensitivity(75.00%) and specificity(57.14%)in contrast-enhanced ultrasonography(P<0.05). Contrast-enhanced ultrasonography showed 82 lesions with high enhancement in the arterial phase, and 48 lesions with low enhancement in the portal venous phase and delayed phase. In the multi-stage dynamic contrast-enhanced CT, 58 lesions showed smooth edge of the capsule and obvious ring enhancement, and the other 18 lesions were characterized by envelope with incomplete enhancement and fuzzy edge.All lesions showed a high-density enhancement in the arterial phase, a reduced enhancement in the portal phase, and a fast-forward and fast-out mode with enhancement fading in the delayed phase. Conclusion The diagnostic accuracy of multi-phase dynamic contrast-enhanced CT in diagnosis of hepatitis B combined with primary liver cancer was higher than that of contrast-enhanced ultrasonography, Multiphase dynamic enhanced CT can more clearly show the type, size and location of the lesion, which is more beneficial to in clinic diagnose and guide treatment.
Objective To compare the diagnostic value of contrast-enhanced ultrasonography and multi-phase dynamic contrast-enhanced CT in patients with hepatitis B combined with primary liver cancer. Methods The data of 56 patients with hepatitis B and primary liver cancer who were treated in our hospital from May 2015 to May 2018 were retrospectively analyzed.The pathological examination results were used as the gold standard to compare the diagnostic rates of different examination methods for primary liver cancer, and to summarize the imaging findings of primary liver cancer. Results The coincidence rate(92.86%), sensitivity(96.43%) and specificity(89.29%) of multi-phase dynamic contrast-enhanced CT in the diagnosis of primary liver cancer were significantly higher than the coincidence rate(71.43%), sensitivity(75.00%) and specificity(57.14%)in contrast-enhanced ultrasonography(P<0.05). Contrast-enhanced ultrasonography showed 82 lesions with high enhancement in the arterial phase, and 48 lesions with low enhancement in the portal venous phase and delayed phase. In the multi-stage dynamic contrast-enhanced CT, 58 lesions showed smooth edge of the capsule and obvious ring enhancement, and the other 18 lesions were characterized by envelope with incomplete enhancement and fuzzy edge.All lesions showed a high-density enhancement in the arterial phase, a reduced enhancement in the portal phase, and a fast-forward and fast-out mode with enhancement fading in the delayed phase. Conclusion The diagnostic accuracy of multi-phase dynamic contrast-enhanced CT in diagnosis of hepatitis B combined with primary liver cancer was higher than that of contrast-enhanced ultrasonography, Multiphase dynamic enhanced CT can more clearly show the type, size and location of the lesion, which is more beneficial to in clinic diagnose and guide treatment.
引文
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[1 5]拉海阿支.动态增强MR I与C T肝灌注成像在肝癌鉴别诊断中的对比分析[J].实用癌症杂志,2016,31(5):855-857.
[2]王立,李敏,黄冬花,等.超声造影与增强CT检查诊断原发性肝癌的价值比较研究[J].实用肝脏病杂志,2 017,24(5):385-387.
[3]沃方明,吴少伯.16层螺旋CT多期动态扫描在肝癌诊断中的应用分析[J].医学影像学杂志,2017,27(5):486-488.
[4]高鑫,张磊.个体特异性MR I多期动态增强扫描对原发性肝癌的诊断价值[J].安徽医学,2016,37(6):676-679.
[5]向森,杨光华,张开芳,等.CT增强扫描与MRI在诊断原发性肝癌患者中临床价值[J].中国CT和MRI杂志,2017,15(7):88-90.
[6]郑信兵.螺旋CT动态增强扫描在原发性小肝癌中的诊断价值[J].肝脏,2017,24(8):484-486.
[7]张力强,唐尧,龚军伟,等.对比增强CT与超声造影对胆嚢局灶性病变诊断价值比较的Meta分析[J].临床放射学杂志,2018,36(2):208-210.
[8]游岚岚,王华,赵立.超声引导下经皮微波固化术治疗肝癌的疗效分析[J].保健医学研究与实践,2016,13(3):64-66.
[9]吴伟慎,赵莹,何海艳,等.天津市乙型和丙型病毒性肝炎相关肝硬化肝癌死亡率及流行特征研究[J].预防医学情报杂志,2016,32(9):941-944.
[10]Lan D,Qu H C,Li N,et al.The Value of Contrast-Enhanced Ultrasonography and ContrastEnhanced CT in the Diagnosis of Malignant Renal Cystic Lesions:A Meta-Analysis[J].Plos One,2016,11(5):e0155857.
[11]彭泽昇,熊莉.低剂量多层螺旋CT动态增强扫描并超声造影对小肝癌诊断价值[J].齐鲁医学杂志,2017,31(5):524-526.
[12]周福明,周晓锋,刘凤容,等.成都市某县恶性肿瘤死亡分析[J].职业卫生与病伤,201 3,28(6):344-347.
[13]叶桂宏,杨红.超声造影在肝癌射频消融前后的应用价值研究[J].中国全科医学,2015,17(9):1090-1093.
[14]Sato T,Kondo F,Ebara M,et a l.Natural history of large regenerative nodules and dysplast ic nodules in liver cirrhosis:28-year followu p s tudy[J].Hepatology interna tional,2015,9(2):330-336.
[1 5]拉海阿支.动态增强MR I与C T肝灌注成像在肝癌鉴别诊断中的对比分析[J].实用癌症杂志,2016,31(5):855-857.