摘要
目的 探讨高频超声及超声附加方法观察肝表面被膜形态的异常程度及半定量化分级对肝纤维化、肝硬化的诊断价值。方法 经手术及病理证实的肝硬化患者 1 2 7例为病变组 ,以因其他肿瘤行手术治疗而临床无阳性发现并经手术肉眼观察判断非肝硬化患者 56例为对照组 ,采用高频探头、二次谐波成像、局部放大图像、调节聚焦和适当降低增益等 5种超声附加方法观察肝被膜形态及厚度等。评价标准分为 5个等级 :肝被膜细而平整为 0级 ;肝被膜轻度增厚、回声增强为Ⅰ级 ;肝被膜增厚、呈细水纹状欠平整为Ⅱ级 ;肝被膜明显增厚、呈小结节状或节段状不连续为Ⅲ级 ;肝被膜明显增厚 ,呈波浪状凹凸不平为Ⅳ级。对本组病例肝圆韧带结构形态的观察 :细而平整、厚度≤ 2mm为正常 ;增厚、不平整、回声增强等为异常表现。结果 病变组 1 2 7例中 ,肝被膜显示 0级 1 1例 ,Ⅰ级 2 1例 ,Ⅱ级 2 7例 ,Ⅲ级 32例 ,Ⅳ级 36例。对照组 56例中显示 0级 48例 ,Ⅰ～Ⅱ级 8例。依据此分级评价标准检测肝被膜形态异常程度 ,敏感性91 .3 % ,特异性 85 .7% ,正确率 89.6 %。病变组肝内韧带异常者 ,肝纤维化占 75 .0 % (9/ 1 2例 ) ,肝硬化占95 .5 % (64/ 67例 ) ;而正常组仅 4例 (8.9% )异常。结论 对肝被膜结构细微变化的分级 。
Objective To observe the degree of liver su rface abnormality using high frequency probes and additional methods and to investigate the diagnostic value of semi-quatitative grading in liver fibrosis and cirrhosis. Methods One hundred and twenty-seven cases of cirrhosis (including 83 cases of hepatocelular carcinoma) confirmed by operation and pathology were enrolled in the group while 56 cases of non-cirrhotic patients with no clinical signs and negative surgical gross findings (operation for other kinds of tumors) served as the control. Five additional methods such as high frequency probes, harmonic technique, local zooming out, regulating focus and decreasing gain were used to observe the configuration and thickness of liver surface. Five-grade classification of liver surface was adopted as follows: thin and regular-grade 0; slightly thickened with increased echogenicity-grade Ⅰ; thickened like fine ripples-grade Ⅱ; significantly thickened with segmental incontinuence-grade Ⅲ; significantly thickened like waves-grade Ⅳ. Observation on configuration of the round ligament: thin, regular with the thickness ≤2 mm was considered as normal whereas thickened, irregular with increased echogenicity as abnormal. Results Of the 127 cases in the study group, 11 cases were grade 0, and grade Ⅰ 21 cases, grade Ⅱ 27 cases, grade Ⅲ 32 cases, grade Ⅳ 36 cases. In the control group there were 48 cases of grade 0 and 8 cases of grade Ⅰ-Ⅱ. The sensitivity, specificity and accuracy of liver surface detection with this method were 91.3-%, 85.7-%, 89.6-%, respectively. 75% (9/12 cases) patients with liver fibrosis and 95.5%- patients ( 64/67- cases) with cirrhosis were found with abnormality of hepatic ligaments in the study group. While only 4 cases ( 8.9-%) with abnormality appeared in the control group.Conclusions Grading of changes in liver surface might sensitively reflect their pathological changes. In addition, it would be a reliable method in the diagnosis of liver fibrosis and early stage cirrhosis as well as a semi-quatitative diagnostic tool for advancement of diffuse liver diseases.
出处
《中华超声影像学杂志》
CSCD
2003年第8期478-481,共4页
Chinese Journal of Ultrasonography
基金
首都医学发展科研基金项目(ZD19990 9)
北京市重大科技计划项目(H0 2 0 92 0 0 2 0 4 90 )
