摘要
目的探讨超声造影(CEUS)联合超微血管成像(SMI)在良恶性肝脏局灶性病变(FLL)鉴别诊断中的临床价值。方法选取我院经病理确诊的105例FLL患者,其中良性56例,恶性49例,均于术前行CEUS和SMI检查,分析CEUS、SMI及两者联合应用诊断良恶性FLL的灵敏度、特异度、准确率、阳性预测值、阳性预测值,分析其与病理结果的一致性;绘制受试者工作特征(ROC)曲线分析CEUS、SMI及两者联合应用鉴别FLL的诊断效能。结果CEUS检查显示,良恶性FFL动脉期、门脉期、延迟期增强表现比较差异均有统计学意义(均P<0.001);SMI检查显示,良恶性FFL血管形态特征比较差异有统计学意义(P<0.001)。CEUS诊断良恶性FLL的灵敏度、特异度、准确率、阳性预测值、阳性预测值分别为79.60%、80.40%、80.00%、78.00%、81.82%,与病理结果的一致性一般(Kappa=0.599,P<0.05);SMI诊断良恶性FLL的灵敏度、特异度、准确率、阳性预测值、阳性预测值分别为65.30%、66.10%、65.71%、62.75%、68.52%,与病理结果的一致性差(Kappa=0.313,P<0.05);两者联合应用诊断良恶性FLL的灵敏度、特异度、准确率、阳性预测值、阳性预测值分别为89.80%、92.90%、90.48%、89.80%、92.90%,与病理结果的一致性好(Kappa=0.809,P<0.001)。CEUS、SMI与两者联合应用的准确率比较差异均有统计学意义(χ^(2)=4.579、18.818,均P<0.05);CEUS与两者联合应用的灵敏度、特异度比较,差异均无统计学意义;SMI与两者联合应用的灵敏度、特异度比较,差异均有统计学意义(χ^(2)=8.440、10.394,均P<0.05)。ROC曲线分析显示,CEUS与SMI联合应用鉴别诊断良恶性FLL的曲线下面积(AUC)为0.913,高于CEUS、SMI单独应用(0.800、0.657),差异均有统计学意义(Z=2.046、2.634,均P<0.05)。结论CEUS联合SMI鉴别诊断良恶性FLL具有较好的临床价值。
Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS)combined with superb microvascular imaging(SMI)in the differential diagnosis of benign and malignant focal liver lesions(FLL).Methods A total of 105 patients with FLL diagnosed pathologically in our hospital were selected,including 56 cases of benign lesions and 49 cases of malignant lesions.CEUS and SMI were performed before surgery.The sensitivity,specificity and accuracy of CEUS,SMI and their combined application in the diagnosis of benign and malignant FLL were analyzed,and their consistency with pathological results was analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the differential diagnostic efficacy of FLL by CEUS,SMI and their combination.Results CEUS showed that there were significant differences in the enhancement of arterial phase,portal phase and delayed phase between benign and malignant FFL(all P<0.001).SMI showed that the characteristics of vascular morphology between benign and malignant FFL was significantly different(all P<0.001).The sensitivity,specificity,accuracy,positive predictive value and positive predictive value of CEUS in the diagnosis of benign and malignant FLL were 79.60%,80.40%,80.00%,78.00%and 81.82%,respectively,which was generally consistent with the pathological results(Kappa=0.599,P<0.05).The sensitivity,specificity,accuracy,positive predictive value and positive predictive value of SMI in the diagnosis of benign and malignant FLL were 65.30%,66.10%,65.71%,62.75%and 68.52%,respectively,which was poor consistent with the pathological results(Kappa=0.313,P<0.05).The sensitivity,specificity,accuracy,positive predictive value,positive predictive value of CEUS combined with SMI in the diagnosis of benign and malignant FLL were 89.80%,92.90%,90.48%,89.80%,92.90%,respectively,which was good consistent with pathological results(Kappa=0.809,P<0.001).The accuracy of CEUS,SMI and their combination were significantly different(χ^(2)=4.579,18.818,both P<0.05).There were no significant differences in sensitivity and specificity between CEUS and the combination of CEUS and SMI.There were significant differences in sensitivity and specificity between SMI and the combination of SMI and CEUS(χ^(2)=8.440,10.394,both P<0.05).ROC curve analysis showed that the area under the curve of the combination of CEUS and SMI in the differential diagnosis of benign and malignant FLL was 0.913,which was hither than that of CEUS and SMI applied alone(0.800,0.657),the differences were statistically significant(Z=2.046,2.634,both P<0.05).Conclusion CEUS combined with SMI has good clinical value in the differential diagnosis of benign and malignant FLL.
作者
郝菲
徐梓祎
原韶玲
HAO Fei;XU Ziyi;YUAN Shaoling(Department of Ultrasound,Taiyuan Xishan Hospital,Taiyuan 030053,China)
出处
《临床超声医学杂志》
CSCD
2023年第12期1024-1028,共5页
Journal of Clinical Ultrasound in Medicine
关键词
超声检查
造影剂
超微血管成像
肝脏局灶性病变
良恶性
Ultrasonography
Contrast agent
Superb microvascular imaging
Focal liver lesion,benign and malignant
