超声造影与增强螺旋CT诊断肝细胞癌的对比研究

摘要

Objective To compare the diagnostic value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced helical computed tomography (CECT) for hepatocellular carcinoma (HCC) with liver cirrhosis. Methods Two hundreds and forty-one focal liver lesions in 207 patients with Hepatitis B virus (HBV) cirrhosis were detected with CEUS and CECT, respectively. Pathological results were used as"gold standard"to compare the two methods. Diagnostic results of the two methods were compared with pathological results. Differences were assessed using the McNemar test, and the Kappa test was used for consistency evaluation. Results (1) For 113 liver lesions that were ≤2 cm, the number of HCC lesions was 63, and the number of benign lesions was 50. There were no significant differences in results of CEUS and CECT compared with that of the "gold standard" of McNemar test results (P = 0.824, P = 0.082). Consistency of the Kappa test results of CEUS and CECT in comparison with the "gold standard" was general (Kappa = 0.643, Kappa = 0.421). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HCC diagnosed by CEUS were higher than those of CECT. The rate of arterial enhancement was better for CEUS [87.30% (55/63)] than that for CECT [69.84%(44/63),χ2=5.704, P=0.017]. (2) For 128 liver lesions that were>2 cm, the number of HCC lesions was 77, and the number of benign lesions was 51. There were no significant differences in the diagnostic results between McNemar test and CEUS and CECT tests (P = 0.481, P = 0.167). Consistency of the Kappa test results of CEUS and CECT and "gold standard" was general (Kappa = 0.710, Kappa = 0.697). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HCC were not different between two diagnostic methods. The rate of arterial enhancement was 89.61%(69/77) for CEUS and 85.71%(66/77) for CECT, and there was no significant difference between the two groups (χ2=0.540, P=0.462). Conclusion For HCC≤2 cm, the diagnostic performance of CEUS is better than that of CECT. For HCC>2 cm, the diagnostic performance is similar for the two diagnostic methods.%目的 比较超声造影(CEUS)与增强螺旋CT(CECT)对肝硬化背景下肝细胞癌(HCC)的诊断效能.方法 对207例241个乙肝肝硬化背景下肝脏局灶性病变进行CEUS和CECT检查,以病理结果 为"金标准",将两种检查方法的诊断结果 与病理结果 进行对比,诊断差异性评价采用McNemar检验,一致性评价采用Kappa检验.结果 (1)病理结果 显示,113个≤2 cm的病灶中,HCC病灶63个,良性病变50个.CEUS、CECT对比"金标准"McNemar检验的差别均无统计学意义(P分别为0.824、0.082),Kappa检验CEUS、CECT与"金标准"结果 一致性一般(Kappa值分别为0.643、0.421);CEUS诊断HCC的敏感度、特异度、阳性预测值、阴性预测值和准确度均高于CECT.在显示动脉期血供方面,CEUS增强显示率高于CECT[87.30%(55/63)vs.69.84%(44/63),χ2=5.704,P=0.017].(2)病理结果 显示,128个>2 cm的病灶中,HCC病灶77个,良性病变51个.CEUS、CECT对比"金标准"McNemar检验的差别均无统计学意义(P分别为0.481、0.167),Kappa检验CEUS、CECT与"金标准"结果 一致性一般(Kappa值分别为0.710、0.697);两者诊断HCC的敏感度、特异度、阳性预测值、阴性预测值和准确度差异不大.在显示动脉期血供方面,CEUS增强显示率与CECT差异无统计学意义[89.61%(69/77)vs.85.71%(66/77),χ2=0.540,P=0.462].结论 对于直径≤2 cm的HCC,CEUS诊断的效果优于CECT;对于直径>2 cm的HCC而言,两者的诊断能力是相似的.