CAJ | 학술논문

目的：探讨实时剪切波弹性成像( real time of shear wave elastography, SWE)与超声造影( contrast en-hanced ultrasound, CEUS)技术在鉴别诊断肝脏肿瘤性质中的临床价值差异。方法回顾性分析河南省传染病医院2012年7月—2014年7月收治的术前均接受SWE、CEUS检测,在本院接受手术治疗并进行术后病理检查的肝脏肿瘤患者98例的临床资料,计算两种检测方法的诊断学评价指标。结果98例共发现108个病灶,术后病理确诊肝血管瘤30例、肝细胞癌38例、肝转移癌28例、肝内胆管细胞癌2例。肝恶性肿瘤患者的杨氏模量值、杨氏模量比值均显著低于肝良性肿瘤患者(P<0．01)。 SWE检查结果与术后病理学检查结果的一致性好(Kappa=0.836,P<0．01),诊断肝恶性肿瘤的灵敏度92.65%、特异度93.33%、误诊率6.67%、漏诊率7.35%；AUC为0.912。 CEUS检查结果与术后病理学检查结果的一致性好(Kappa=0.790,P<0．01),诊断肝恶性肿瘤的灵敏度91.18%、特异度90.00%、误诊率10.00%、漏诊率8.82%；ROC曲线下面积(AUC)为0.880。在SWE检查中未发生不良反应；CEUS检查中发生中、轻度不良反应9例,均自行缓解或予对症处理后缓解。结论 SWE在鉴别诊断肝脏肿瘤良、恶性方面与病理检查的一致性较好,与CEUS鉴别诊断能力相当,因其具有无创、安全、快捷等优点,可作为临床快速鉴别诊断肝脏良、恶性肿瘤的一种方法。
목적：탐토실시전절파탄성성상( real time of shear wave elastography, SWE)여초성조영( contrast en-hanced ultrasound, CEUS)기술재감별진단간장종류성질중적림상개치차이。방법회고성분석하남성전염병의원2012년7월—2014년7월수치적술전균접수SWE、CEUS검측,재본원접수수술치료병진행술후병리검사적간장종류환자98례적림상자료,계산량충검측방법적진단학평개지표。결과98례공발현108개병조,술후병리학진간혈관류30례、간세포암38례、간전이암28례、간내담관세포암2례。간악성종류환자적양씨모량치、양씨모량비치균현저저우간량성종류환자(P<0．01)。 SWE검사결과여술후병이학검사결과적일치성호(Kappa=0.836,P<0．01),진단간악성종류적령민도92.65%、특이도93.33%、오진솔6.67%、루진솔7.35%；AUC위0.912。 CEUS검사결과여술후병이학검사결과적일치성호(Kappa=0.790,P<0．01),진단간악성종류적령민도91.18%、특이도90.00%、오진솔10.00%、루진솔8.82%；ROC곡선하면적(AUC)위0.880。재SWE검사중미발생불량반응；CEUS검사중발생중、경도불량반응9례,균자행완해혹여대증처리후완해。결론 SWE재감별진단간장종류량、악성방면여병리검사적일치성교호,여CEUS감별진단능력상당,인기구유무창、안전、쾌첩등우점,가작위림상쾌속감별진단간장량、악성종류적일충방법。
Objective To investigate the differences in clinical values between real-time shear wave elastography ( SWE) and contrast enhanced ultrasound ( CEUS) technology in differential diagnosis of liver tumors. Methods Clini-cal data of 98 patients with liver tumors admitted during July 2012 and July 2014, who undergoing preoperative SWE and CEUS detections and postoperative pathological examination, was retrospectively analyzed. The diagnostic evaluation in-dexes of the two methods were calculated. Results A total of 108 lesions were found in the 98 patients. The postopera-tive pathology showed that there were 30 patients with hepatic haemangioma, 38 patients with hepatocellular carcinoma, 28 patients with hepatic metastatic carcinoma and 2 patients with intrahepatic cholangiocellular carcinoma. Both Young modulus value P and Young modulus ratio in patients with malignant liver tumors were significantly smaller than those in patients with benign liver tumors ( P<0. 01 ) . Examination results between SWE and postoperative pathology showed a good consistency (Kappa=0. 836, P<0. 01), and its sensitivity, specificity, misdiagnosis rate and missed diagnosis rate in diagnosis of malignant liver tumors were 92. 65%, 93. 33%, 6. 67% and 7. 35% respectively; the AUC was 0. 912. A good consistency was shown between the results of CEUS examination and postoperative pathologic examination (Kappa=0. 790, P<0. 01), and its sensitivity, specificity, misdiagnosis rate and missed diagnosis rate in diagnosis of malignant liver tumors were 91. 18%, 90. 00%, 10. 00% and 8. 82% respectively;area under the ROC curve ( AUC) was 0. 880. There was no adverse effect during the SWE examination. A total of 9 patients had moderate and mild adverse effects during CEUS examination, and the symptoms were spontaneously relieved or relieved after corresponding treat-ment. Conclusion Real-time shear wave elastography in the differential diagnosis of benign and malignant hepatic tumors has a better consistency with pathological examination, and has an equivalent effect with CEUS differential diagno-sis. It can be used as a method for the quickly differential diagnosis of benign and malignant hepatic tumors in clinical practice because of its noninvasiveness, safety and rapidity.