超声造影与增强MRI对高分化肝癌和异型增生结节的诊断

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。

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

ObjectiveTo evaluate the diagnostic performance of contrast-enhanced ultrasound and contrast-enhanced MRI for well-differentiated hepatocellular carcinoma (HCC) and dysplastic nodules (DNs). MethodsThirty-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. ResultsFor 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). ConclusionCEUS combined with enhanced MRI is helpful for differential diagnosis of well-differentiated HCC and DNs, while CEUS has a higher specificity.