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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (03) : 200 -205. doi: 10.3877/cma.j.issn.1672-6448.2022.03.003

腹部超声影像学

超声造影与增强MRI对高分化肝癌和异型增生结节的诊断
范培丽1, 毛枫1, 季正标1, 曹佳颖1, 盛若凡2, 王文平1,†()   
  1. 1. 200032　上海，复旦大学附属中山医院超声科；200032　上海，复旦大学附属中山医院放射科；200032　上海，上海市影像医学研究所
    2. 200032　上海，复旦大学附属中山医院放射科；200032　上海，复旦大学超声医学与工程研究所
  • 收稿日期:2020-06-08 出版日期:2022-03-01
  • 通信作者: 王文平
  • 基金资助:
    上海市临床重点专科项目经费资助(shslczdzk03501); 上海申康中心重大临床研究项目(SHDC2020CR1031B); 上海市自然科学基金项目(20ZR1452800)

Contrast-enhanced ultrasound versus contrast-enhanced MRI for diagnosis of well-differentiated hepatocellular carcinoma and precancerous lesions

Peili Fan1, Feng Mao1, Zhengbiao Ji1, Jiaying Cao1, Ruofan Sheng2, Wenping Wang1,†()   

  1. 1. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Shanghai 200032, China; Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai 200032, China
    2. Shanghai Institute of Medical Imaging, Shanghai 200032, China; Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Received:2020-06-08 Published:2022-03-01
  • Corresponding author: Wenping Wang
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引用本文：

范培丽, 毛枫, 季正标, 曹佳颖, 盛若凡, 王文平. 超声造影与增强MRI对高分化肝癌和异型增生结节的诊断[J/OL]. 中华医学超声杂志（电子版）, 2022, 19(03): 200-205.

Peili Fan, Feng Mao, Zhengbiao Ji, Jiaying Cao, Ruofan Sheng, Wenping Wang. Contrast-enhanced ultrasound versus contrast-enhanced MRI for diagnosis of well-differentiated hepatocellular carcinoma and precancerous lesions[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(03): 200-205.

目的

探讨超声造影与增强MRI对高分化肝细胞癌和肝异型增生结节（DN）的诊断能力。

方法

回顾性收集2012年1月至2018年12月在复旦大学附属中山医院同期行超声造影和增强MRI检查并获病理学证实的39例患者的39个高分化肝细胞癌病灶和7例患者的8个DN病灶，分析其超声造影和增强MRI表现特征。采用χ2检验，计算Kappa值，比较2种检查方法的诊断一致性；绘制不同检查方法的受试者操作特征（ROC）曲线，分析其诊断效能。

结果

2种诊断方法中，69.2%（27/39）的高分化肝细胞癌的动脉期表现一致（Kappa=0.482），53.8%（21/39）的高分化肝细胞癌的延迟期表现一致（Kappa=0.168）。DN病灶在超声造影的主要表现呈“等增强-等增强”模式（87.5%，7/8），增强MRI主要表现为“高信号-低信号”模式（62.5%，5/8），所有DN病灶在超声造影延迟期均未出现廓清。超声造影、增强MRI、超声造影联合增强MRI（同时满足或只满足一种）4种检查方法中，超声造影联合增强MRI（只满足一种）诊断高分化肝细胞癌的敏感度（66.7%）和准确性（61.7%）最高，而超声造影诊断高分化肝细胞癌的特异度（100%）和ROC曲线下面积（0.658，95%CI：0.482~0.834）最高。

结论

超声造影联合增强MRI有助于高分化肝细胞癌和肝DN的鉴别诊断，而超声造影具有更高的诊断特异度。

关键词: 肝细胞癌, 异型增生结节, 超声, 磁共振成像
Objective

To evaluate the diagnostic performance of contrast-enhanced ultrasound and contrast-enhanced MRI for well-differentiated hepatocellular carcinoma (HCC) and dysplastic nodules (DNs).

Methods

Thirty-nine patients with 39 well-differentiated HCC and seven patients with eight DNs pathologically confirmed who underwent contrast-enhanced ultrasound (CEUS) and enhanced MRI at Zhongshan Hospital of Fudan University from January 2012 to December 2018 were enrolled. Imaging features and diagnostic efficacy of the two imaging methods were analyzed. Chi-square test and Kappa value were used to compare the consistency of the two imaging methods. Receiver operator characteristic (ROC) curve analysis was performed to calculate the diagnostic efficiency of the two imaging methods.

Results

For the two imaging methods, the consistency of arterial phase enhancement patterns of well-differentiated HCC was 69.2% (27/39) and Kappa value was 0.482. The consistency of late phase enhancement patterns of well-differentiated HCC was 53.8% (21/39) and Kappa value was 0.168. The major enhancement pattern of DNs was "iso-enhancement~iso-enhancement" on CEUS, and "hyperintensity~hypointensity" on contrast-enhanced MRI. No DNs exhibited washout in the late phase on CEUS. Among the four examination methods, CEUS, enhanced MRI, and CEUS combined with enhanced MRI (detected by both or by either), the sensitivity (66.7%) and accuracy (61.7%) of CEUS combined with enhanced MRI (detected by either) were highest for the diagnosis of well-differentiated HCC, while CEUS had the highest specificity (100%) and area under the ROC curve (0.658, 95%CI: 0.482-0.834).

Conclusion

CEUS combined with enhanced MRI is helpful for differential diagnosis of well-differentiated HCC and DNs, while CEUS has a higher specificity.

Key words: Hepatocellular carcinoma, Dysplastic nodule, Ultrasound, Magnetic resonance imaging
图1 82 岁男性高分化肝细胞癌病例超声造影及增强MRI 图像。图a 为常规灰阶超声显示肝右叶见29 mm×20 mm稍高回声病灶（箭头所示）；图b为超声造影动脉期病灶（17 s）呈高回声增强（箭头所示），内见小片状未增强区（*）；图c 为超声造影延迟期（180 s），病灶出现造影剂不均匀廓清呈低回声增强（箭头所示）；图d 为增强MRI 动脉期，病灶强化呈高信号（箭头），内见较大范围未强化区（*）；图e为增强MRI延迟期，病灶周边强化进展（高信号范围增大，箭头所示），中央见未强化区
表1 39个高分化肝细胞癌病灶超声造影与增强MRI动脉期表现比较（个）
增强MRI 超声造影
高增强 局部高增强 等增强 低增强
高信号 21 2 0 1
局部高信号 0 4 1 2
等信号 2 0 2 4
表2 39个高分化肝细胞癌病灶超声造影与增强MRI延迟期表现比较（个）
增强MRI 超声造影
等增强 低增强
高信号 0 3
等信号 10 2
低信号 13 11
图2 54岁男性肝异型增生结节病例超声、增强MRI和病理图像。图a为常规灰阶超声显示肝右叶下角见8 mm×8 mm等回声团块，边界不清（箭头所示）；图b 为超声造影动脉期（22 s）病灶呈整体高回声增强（箭头）；图c 为超声造影延迟期（344 s），病灶仍呈高回声增强（箭头）；图d 为增强MRI动脉期，病灶呈高信号强化（箭头）；图e 为增强MRI延迟期，病灶廓清呈低信号（箭头）；图f 为镜下病理图片，显示细胞较小，中度异型，密度增加，核/浆比增高（HE×200）
表3 8个异型增生结节病灶的超声造影与增强MRI动脉期-延迟期表现比较（个）
增强MRI 超声造影
等增强-等增强 高增强-高增强
高信号-低信号 4 1
高信号-等信号 1 0
等信号-低信号 1 0
等信号-等信号 1 0
图3 超声造影和增强MRI诊断高分化肝细胞癌的受试者操作特征曲线注：超声造影联合增强MRI 1为超声造影和增强MRI其中一种符合肝细胞癌诊断标准；超声造影联合增强MRI 2为超声造影和增强MRI同时符合肝细胞癌诊断标准
表4 超声造影和增强MRI对高分化肝细胞癌的诊断效能比较［%（个/个）］
诊断方法 敏感度 特异度 准确性
超声造影 33.3（13/39） 100（8/8） 44.7（21/47）
增强MRI 53.8（21/39） 37.5（3/8） 51.1（24/47）
超声造影联合增强MRI（同时满足） 17.9（7/39） 100（8/8） 31.9（15/47）
超声造影联合增强MRI（满足其中1种） 66.7（26/39） 37.5（3/8） 61.7（29/47）
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