实时超声造影鉴别诊断脂肪肝背景下肝内低回声病变良恶性的临床价值

摘要

目的：总结常规超声所见的脂肪肝背景下肝内低回声病变的特点，应用实时超声造影（CEUS）进行鉴别诊断。方法本研究对128例常规超声检查发现脂肪肝背景下的肝内低回声病变进行CEUS检查，对考虑恶性与高度怀疑恶性及部分诊断良性的病灶（共52例）进行超声引导下穿刺活检，其余76例经临床综合诊断证实为良性，对比常规超声与超声造影图像特点并进行定期随访。计算超声造影与常规超声诊断的灵敏度、特异度、约登指数以及ROC曲线下面积，对超声造影和常规超声诊断结果应用Kappa检验进行信度分析。结果128例患者中共23例恶性病变，105例良性病变。超声造影与常规超声诊断肝内恶性病灶的灵敏度、特异度、约登指数分别为95．65％、98．10％、93．75％与87．00％、91．43％、84．43％。超声造影检查脂肪肝背景下低回声病灶的诊断结果与临床诊断结果比较具有较好的信度（ Kappa＝0．922，P＝00．45）。结论脂肪肝背景下的肝内低回声病灶应当予以重视，超声造影可有效鉴别脂肪肝背景下肝内低回声病变，有助于确诊肝内良恶性病变，明显提高诊断的准确性，减少误诊率。%Objective To summarize the characteristics of low echo lesions by ultrasound findings in fat-ty liver,using real -time contrast -enhanced ultrasonography ( CEUS) for differential diagnosis .Methods The study was examed in 128 cases low echo lesions of fatty liver by using CEUS ,the malignant and the highly suspec-ted malignant and part of the benign lesions (in all the 52 cases)were punctured by ultrasound guided biopsy ,the rest of the 76 cases was confirmed benign by clinical comprehensive diagnosis ,were compared to the characteris-tics about ultrasound and contrast -enhanced ultrasound image and reviewed regular follow -up.We calculated the sensitivity,specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultrasound and apply for Kappa test for reliability analysis to contrast -enhanced ultrasonography and ultra-sound.Results There were 23 malignant lesions and 105 benign lesions in total of 128 patients.The sensitivity, specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultra-sound were 95.65%,98.10%,93.75% and 87.00%,91.43%,84.43%respectively.Compared contrast -en-hanced ultrasound examination diagnosis of low echo lesions in fatty liver with the clinical diagnosis performed good reliability(Kappa=0.922,P=0.045).Conclusion We should pay attention to low echo lesions in the fatty liver.contrast-enhanced ultrasound can effectively identify low echo lesions in the fatty liver ,and identify benign and malignant lesions in the liver ,and improve obviously the accuracy of diagnosis ,and reduce the misdi-agnosis rate.