摘要
目的评价剪切波弹性成像（shear wave elastography, SWE）在肝局灶性病变鉴别诊断中的应用价值。方法接受SWE检查并获得明确诊断的148例患者共155个病灶纳入研究，其中肝细胞癌（hepatocellular carcinoma，HCC）75个，肝内胆管细胞癌（intrahepatic cholangiocarcinoma，ICC）14个，转移性肝癌（metastasis liver cancer，MLC）24个，血管瘤31个，局灶性结节增生（focal nodular hyperplasia，FNH）11个。测量病灶及邻近肝实质杨氏模量平均值（Emean）、最大值（Emax）及离散度（ESD），以kPa表示。比较良恶性及各组病灶之间杨氏模量差异，应用ROC曲线选择鉴别病灶良恶性的最佳诊断界值。结果①恶性病灶的Emean（45．40±20．83）、Emax（77．75±40．67）及ESD（12．08±9．01）分别大于良性病灶（18．12±11．80、23．55±13．82、2．75±1．85）（P〈0．001）。②ICC和MLC的Emean、Emax及ESD分别为（57．85±15．45、104．70±36．87、14．45±7．70）和（59．28±33．00、100．70±52．45、18．23±13．60），分别大于HCC（38．63±11．75、64．64±30．05、9．61±5．97）（P〈0．01），ICC与MLC之间差异均无统计学意义。HCC的Emax和ESD分别大于FNH（37．52±12．78、3．54±1．96）（P〈0．001），但Emean之间差异无统计学意义。FNH的Emean（30．62±11．93）和Emax分别大于血管瘤（13．68±8．07、18．89±10．79）（P〈0．001），但ESD之间差异无统计学意义。③HCC邻近肝实质较MLC、血管瘤及FNH邻近肝实质硬（P〈0．05）。④病灶Emean、Emax和ESD对良恶性诊断的ROC曲线下面积分别为0．909、0．957、0．956，分别以24．82kPa、39．28kPa、5．35kPa为界点，敏感性及特异性分别为93．81％及76．19％、90．57％及85．00％、84．62％及92．50％。结论SWE能够定量分析肝局灶性病变的弹性特征，尤其是Emax和ESD能为病灶良恶性及HCC与其他类型肿瘤的鉴别诊断提供更多的信息。
Objective To evaluate the value of shear wave elastography （SWE） on differential diagnosis of local liver lesions （FLLs）.Methods A total of 148 patients with 155 lesions including hepatocellular carcinoma （ HCC, n = 75）, intrahepatic cholangiocarcinoma （ICC, n = 14）, metastasis liver cancer （MLC, n = 24）, hemangioma （ n = 31 ）, focal nodular hyperplasia （FNH, n = 11 ） were studied. Mean,max and standard deviation SWE values （Emean, Emax, ESD） of both lesion and adjacent liver parenchyma were measured. All parameters were expressed as kPa. Compared the difference between malignant and benign group as well as between each two groups,and ROC curve was used to determine the optimal cut-off point for differential diagnosis malignant and benign lesions. Results ①Emean, Emax and ESD of malignant lesions were higher than those of benign ones （45.40 ± 20.83 vs 18.12 ± 11.80,77.75 ± 40.67 vs23.55±13.82,12.08±9.01 vs 2.75±1.85） （P 〈0.001）.②Emean,Emaxand ESD of ICC （57.86 ±15.45,104.70±36.87,14.45± 7.70） and MLC （59.28 ± 33.00,100.70 ± 52.46,18.23 ± 13.60） were higher than those of HCC （38.63 ± 11.75,64.64 ± 30.05,9.61 ± 5.97） （ P 〈0.01）, whereas no significant difference was found between MLC and ICC for all three parameters.Emax and ESD of HCC were higher than those of FNH （37.52 ± 12.78,3.54 ±1.96） （ P 〈0.001）, whereas Emean did not show significant difference.Emean （30.62± 11.93） and Emax of FNH were higher than those of hemangioma （13.68 ± 8.07, 18.89 ± 10.79） （P 〈 0.001）, whereas ESD did not show significant difference. ③ Adjacent liver parenchyma of HCC was stiffer than which of MLC,hemangioma and FNH （ P 〈0.05）.④For differentiation malignant from benign FLLs, area under ROC curve of Emean, Emax and SSD of lesion were 0.909,0.957,0.956, respectively.Taking Emean 24.82 kPa,Emax 39.28 kPa,ESD5.35 kPa as cut-off point,sensitivity and specificity were 93.81 % and 76.19% ,90.57% and 85.00%,84.62% and 92.50%, respectively. Conclusions SWE could quantitatively analyze elasticity characteristics of FLLs, especially Emax and ESD could provide more information for differential diagnosis between malignant and benign lesions as well as between HCC and other types of tumour.
出处
《中华超声影像学杂志》
CSCD
北大核心
2014年第6期497-501,共5页
Chinese Journal of Ultrasonography
关键词
超声检查
肝肿瘤
剪切波弹性成像
Ultrasonography
Liver tumour
Shear wave elastography
