黃志平　許松　楊貽金　郭德全　鄧文嬌　林霖

[關(guān)鍵詞] 超聲造影;肝病灶;鑒別診斷;穿刺活檢;病理

[中圖分類號(hào)] R445.1? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）22-0131-05

Value of contrast-enhanced ultrasound in differential diagnosis of liver disease foci less than 2 cm

HUANG Zhiping? ?XU Song? ?YANG Yijin? ?GUO Dequan? ?DENG Wenjiao? ?LIN Lin

Department of Ultrasonography， Ganzhou City People′s Hospital in Jiangxi Province， Ganzhou? ?341000， China

[Abstract] Objective To explore the value of contrast-enhanced ultrasound （CEUS） in the differential diagnosis of benign and malignant liver disease foci less than 2 cm. Methods A total of 52 patients underwent routine liver ultrasound and CEUS examinations in our hospital from June 2019 to March 2020， and 41 patients with liver disease foci less than 2 cm were selected as the research subjects， and the diagnostic data of the two examination methods were analyzed. According to the probability of benign and malignant， the patients were divided into 5 categories for benign and malignant diagnosis and ROC curve analysis， and the value of the two examination methods in differential diagnosis of benign and malignant liver diseases less than 2 cm was compared. Results Among the 52 liver CEUS patients， 41 patients （78.85%） had liver disease foci less than 2 cm， including 3 patients with 2 foci and 38 patients with a single focus， and a total of 44 foci were observed. A total of 21 malignant foci and 23 benign foci were finally diagnosed. The sensitivity， specificity and accuracy of CEUS were 100.00%（21/21），91.30% （21/23） and 95.45%（42/44），respectively， while those of conventional ultrasound were 85.71%（18/21），60.87%（14/23） and 72.73%（32/44）， respectively. The area under the ROC curve of CEUS diagnosis （0.997） was larger than that of conventional ultrasound diagnosis （0.820， P<0.05）. Conclusion Contrast-enhanced ultrasound can observe the enhanced and subsided modes of foci radiography throughout the whole process. For small foci with a diameter <2 cm， CEUS has high sensitivity， specificity and accuracy， and strong ability of differential diagnosis， showing a good application prospect.

[Key words] Contrast-enhanced ultrasound （CEUS）; Liver disease foci; Differential diagnosis; Puncture biopsy; Pathology

肝結(jié)節(jié)通常是由于各種因素影響而引起肝臟纖維組織增生，從而使得肝小梁排列順序紊亂而形成[1]。臨床常見(jiàn)的肝結(jié)節(jié)病灶主要包含肝局灶性結(jié)節(jié)樣增生、肝結(jié)節(jié)狀再生性增生、肝硬化、肝腺瘤及肝部分結(jié)節(jié)樣變[2]。當(dāng)病患機(jī)體出現(xiàn)結(jié)節(jié)時(shí)，則表明其肝臟組織已經(jīng)開(kāi)始出現(xiàn)纖維化。因此，及時(shí)對(duì)肝結(jié)節(jié)進(jìn)行有效診斷，并采取相應(yīng)治療措施，對(duì)改善疾病預(yù)后具有積極意義。我國(guó)是肝病大國(guó)，每年都有大量患者身受其害。做到早期準(zhǔn)確診斷尤為重要。超聲檢查是肝臟病變首選的影像學(xué)檢查方法，常規(guī)超聲（二維超聲和彩色多普勒超聲）在肝臟病灶的檢出方面具有很高的敏感性，但在病灶的定性方面相對(duì)較弱，尤其是小于2 cm的病灶，因病灶多無(wú)特征性，診斷價(jià)值弱于對(duì)比增強(qiáng)計(jì)算機(jī)斷層成像（Computed tomography，CT）和對(duì)比增強(qiáng)核磁共振成像（Magnetic resonance imaging，MRI）[3]。隨著超聲造影（對(duì)比增強(qiáng)超聲，Contrast enhanced ultrasound，CEUS）技術(shù)的發(fā)展，其在肝臟方面的應(yīng)用越來(lái)越成熟，能夠?qū)崟r(shí)顯示肝內(nèi)病灶的血流灌注過(guò)程，提高定性診斷能力[4]。本研究分析超聲造影對(duì)<2 cm肝病灶的鑒別診斷價(jià)值，現(xiàn)報(bào)道如下。