超声造影与增强磁共振成像对具有慢性肝病背景≤3cm肝细胞癌的诊断效能比较

摘要

目的 比较超声造影与增强磁共振成像在具有肝硬化或慢性乙型肝炎背景的患者中诊断≤3 cm肝细胞癌的能力.方法 选择2005年1月至2016年5月在第三军医大学西南医院行超声造影及增强磁共振成像检查发现单个肝脏结节且结节最大径≤3 cm并具有肝硬化或慢性乙型肝炎背景的患者92例.所有患者均经手术病理证实.以手术病理结果作为诊断“金标准”,计算超声造影、增强磁共振成像及超声造影联合增强磁共振成像诊断≤3 cm肝细胞癌的敏感度、特异度、准确性、阳性预测值、阴性预测值,并采用x2检验或Fisher确切概率法进行比较.结果 92例患者中,肝细胞癌82例,非肝细胞癌10例.超声造影诊断肝细胞癌的敏感度和特异度分别为79.2％ (65/82)及70.0％ (7/10),与增强磁共振成像的74.4％ (61/82)及70.0％ (7/10)比较差异无统计学意义(x2=0.548,P=0.459;P=1.000,采用Fisher确切概率法).超声造影及增强磁共振成像同时满足诊断标准,诊断肝细胞癌的敏感度为61.0％ (50/82),低于单独应用超声造影,且差异有统计学意义(x2=6.548,P=0.010);诊断肝细胞癌的特异度为80.0％ (8/10),与单独应用超声造影比较差异无统计学意义(P=1.000,采用Fisher确切概率法).超声造影或增强磁共振成像满足诊断标准,诊断肝细胞癌的敏感度为92.7％ (76/82),均高于单独应用超声造影或增强磁共振成像,且差异均有统计学意义(x2=6.119,P=0.013;x2=9.976,P=0.002);诊断肝细胞癌的特异度为60.0％ (6/10),与单独应用超声造影或增强磁共振成像比较差异均无统计学意义(P均为1.000,均采用Fisher确切概率法).结论 对于具有肝硬化或慢性乙型肝炎背景的患者,单独应用超声造影对≤3 cm肝细胞癌的诊断能力与单独应用增强磁共振成像相当.联合应用超声造影与增强磁共振成像,可显著提高肝细胞癌的诊断敏感度,但并不能显著提高诊断特异度.%Objective To compare the diagnostic ability of gadolinium diethylene-triamine-pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) and contrast-enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC) ≤ 3 cm in diameter in patients with hepatic cirrhosis or chronic hepatitis B.Methods Ninty-two cases with single focal liver lesion ≤ 3 cm who underwent CEUS and Gd-EOB-DTPA MRI in Southwest Hospital Affiliated to Third Military Medical University were enrolled in the study.And all cases were diagnosed with hepatic cirrhosis or chronic hepatitis B.Pathology was the golden standard and all cases were diagnosed pathologically by surgical operation.Sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate of the diagnosis of small HCC by CEUS,Gd-EOB-DTPA MRI and CEUS combined with Gd-EOB-DTPA MRI were calculated and compared with x2 test or Fisher exact probability.Results Of the 92 cases,82 cases were diagnosed as HCC and the other 10 cases were diagnosed as non-HCC.The sensitivity and the specificity for the diagnosis of HCC was 79.2％ (65/82) and 70.0％ (7/10) of CEUS alone and was comparable with that of Gd-EOB-DTPA MRI [74.4％ (61/82) vs 70.0％ (7/10)] alone (x2=0.548,P=0.459;P=1.000).When both CEUS and Gd-EOB-DTPA MRI met the diagnostic criteria for HCC,the sensitivity was lower [61.0％ (60/82),P=0.010] than that of CEUS alone,and the specificity [80.0％ (8/10),P=1.000] was not statistically different from that of CEUS alone.When CEUS or Gd-EOB-DTPA MRI met the diagnostic criteria for HCC,the sensitivity [92.7％ (76/82)] was higher than that of CEUS alone (x2=6.119,P=0.013) or Gd-EOB-DTPA MRI alone (x2=9.972,P=0.002),and the specificity [60.0％ (6/10)] was not statistically different from that of CEUS alone (P=1.000) or by Gd-EOB-DTPA MRI alone (P=1.000).Conclusions In patients with cirrhosis or chronic hepatitis B,the diagnostic ability of HCC ≤ 3cm in diameter by CEUS alone was comparable to that by Gd-EOB-DTPA MRI alone.Combination of CEUS and Gd-EOB-DTPA MRI may increase the sensitivity for the diagnosis of HCC,but the specificity not statistically improved.