超声造影与增强CT对儿童肝脏良恶性病变诊断价值的对比分析

doi:10.3877/cma.j.issn.1672-6448.2023.09.008

目的

对比超声造影（CEUS）与增强 CT在儿童肝脏良恶性病变中的临床诊断价值。

方法

收集2019年7月至2023年2月经重庆医科大学附属儿童医院收治且同时行CEUS及增强CT扫描的肝脏良恶性肿瘤患儿的影像学资料进行回顾性分析。以病理学诊断及临床诊断为金标准，分析CEUS及增强CT误诊病例的影像学表现，并比较两种影像学方法对肝脏良恶性病变的诊断敏感度、特异度和准确性。

结果

本组共纳入55例患儿，CEUS误诊1例肝血管瘤，误诊率为1.82%（1/55），诊断符合率为98.18%（54/55）；而增强CT误诊5例，包括2例肝母细胞瘤、2例肝血管瘤、1例肝局灶性结节性增生，误诊率为9.09%（5/55），诊断符合率为90.91%（50/55）。CEUS诊断儿童肝脏良恶性局灶性病变的敏感度为100.00%，特异度为95.00%，诊断准确性为98.18%；增强CT的诊断敏感度、特异度及准确性分别为94.29%、90.00%和90.91%，两种方法比较差异均无统计学意义（P均>0.05）。

结论

超声造影有助于鉴别诊断儿童肝脏良恶性肿瘤，具有与增强CT相当的良好诊断价值。

关键词: 超声造影, CT增强扫描, 儿童, 肝肿瘤

Objective

To compare the clinical diagnostic value of contrast enhanced ultrasound (CEUS) and contrast enhanced computed tomography (CECT) for benign and malignant liver lesions in children.

Methods

The imaging data of children with benign and malignant liver tumors admitted to the Children's Hospital of Chongqing Medical University between July 2019 and February 2023, who underwent both CEUS and CECT, were retrospectively analyzed. Using pathological and clinical diagnoses as the gold standard, we analyzed the imaging findings of cases where CEUS and CECT had misdiagnosed the condition. We then compared the sensitivity, specificity, and accuracy of the two imaging modalities in diagnosing benign and malignant liver lesions.

Results

A total of 55 children were included in this study. CEUS had a misdiagnosis rate of 1.82% (1/55), with one case of hemangioma being misdiagnosed, and a diagnostic compliance rate of 98.18% (54/55). CECT, on the other hand, had a misdiagnosis rate of 9.09% (5/55), including two cases of hepatoblastoma, two cases of hemangioma, and one case of focal nodular hyperplasia of the liver, and a diagnostic compliance rate of 90.91% (50/55). The sensitivity of CEUS for diagnosing benign and malignant focal liver lesions in children was 100.00%, with a specificity of 95.00% and an overall diagnostic accuracy of 98.18%. CECT demonstrated a diagnostic sensitivity, specificity, and accuracy of 94.29%, 90.00%, and 90.91%, respectively. There was no significant difference in the diagnostic performance between the two methods (P>0.05).

Conclusion

CEUS is valuable in distinguishing between benign and malignant liver tumors in children and demonstrates a diagnostic performance comparable to that of CECT.

Key words: Contrast enhanced ultrasound, Contrast enhanced computed tomography, Children, Liver neoplasms

图1 肝局灶性结节性增生（病例1）患儿增强CT图像。增强CT示病变（箭头所示）位于肝左叶，动脉期病变呈快速强化，门脉期及延迟期强化较周围正常肝实质低（图a为增强CT动脉期；图b为增强CT门脉期；图c为增强CT延迟期）

图3 肝局灶性结节性增生（病例1）患儿组织病理学图像，镜下见肝细胞呈结节状增生，周围被纤维组织环绕，诊断为肝局灶性结节性增生（HE ×40）

图4 孤立性先天性血管瘤（病例3）患儿增强CT图像。增强CT示肿瘤位于肝实质内（箭头所示），增强病变内见较多稍粗、迂曲、紊乱血管影，病变边缘强化明显，肿瘤内部明显不均匀强化，以门脉期为主，增强CT误诊为肝母细胞瘤（图a为增强CT动脉期；图b为增强CT门脉期；图c为增强CT延迟期）

图6 孤立性先天性血管瘤（病例3）患儿组织病理学图像，镜下见较多扩张的血管腔，部分血管内皮细胞肿胀，诊断为孤立性先天性血管瘤（HE ×40）

表1 5例误诊患儿超声造影、增强CT及病理诊断结果

病例序号	性别	年龄（月）	超声造影	增强CT	病理诊断
1	女	116	肝局灶性结节性增生	血管源性的肿瘤病变	肝局灶性结节性增生
2	女	0.53	多发性肝血管瘤	恶性肿瘤	多发性肝婴幼儿肝血管瘤
3	女	2	肝母细胞瘤	肝母细胞瘤	孤立性先天性肝血管瘤
4	女	10.53	肝母细胞瘤	偏良性肿瘤性病变	高分化胎儿上皮型肝母细胞瘤
5	男	5	肝母细胞瘤	良性肿瘤性病变	胎儿上皮型肝母细胞瘤

表1 5例误诊患儿超声造影、增强CT及病理诊断结果

病例序号	性别	年龄（月）	超声造影	增强CT	病理诊断
1	女	116	肝局灶性结节性增生	血管源性的肿瘤病变	肝局灶性结节性增生
2	女	0.53	多发性肝血管瘤	恶性肿瘤	多发性肝婴幼儿肝血管瘤
3	女	2	肝母细胞瘤	肝母细胞瘤	孤立性先天性肝血管瘤
4	女	10.53	肝母细胞瘤	偏良性肿瘤性病变	高分化胎儿上皮型肝母细胞瘤
5	男	5	肝母细胞瘤	良性肿瘤性病变	胎儿上皮型肝母细胞瘤

表2 超声造影与增强CT对肝脏占位性病变良恶性的诊断结果（%）

检查方法	例数	敏感度	特异度	准确性
增强CT	55	94.29（33/35）	90.00（18/20）	90.91（50/55）
CEUS	55	100.00（35/35）	95.00（19/20）	98.18（54/55）
χ²值		2.059	0.360	2.821
P值		0.151	0.548	0.093

表2 超声造影与增强CT对肝脏占位性病变良恶性的诊断结果（%）

检查方法	例数	敏感度	特异度	准确性
增强CT	55	94.29（33/35）	90.00（18/20）	90.91（50/55）
CEUS	55	100.00（35/35）	95.00（19/20）	98.18（54/55）
χ²值		2.059	0.360	2.821
P值		0.151	0.548	0.093

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Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children

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Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children