| 摘要: |
| 目的 总结误诊为原发性肝细胞肝癌（hepatocellular carcinomas ，HCC）的肝脏局灶性病变的超声造影（contrast-enhanced ultrasound，CEUS）表现，分析误诊原因，进一步提高超声造影诊断价值。方法 2014年6月-2015年10月对132例肝脏局灶性结节性病变患者的198个病灶行CEUS扫查，以病理诊断及临床诊断为金标准，评价CEUS诊断HCC的诊断效能，并着重总结误诊病例CEUS增强特征，分析误诊原因。结果 排除未最后确诊的28例，104例共138个病灶得到病理及临床确诊，其中49例确诊为HCC共57个病灶，CEUS诊断HCC的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为91.23%（52/57）、90.12%(73/81)、86.67%（52/60）、93.59%（73/78）及90.58%（125/138)。55例确诊为非HCC共81个病灶，CEUS诊断为HCC的误诊率为9.88 %（8/81）。所有误诊病灶CEUS均表现为动脉期呈高或等增强，门脉期或延迟期减退为低增强。结论 病灶动脉期呈高或等增强，门脉期或延迟期减退为低增强的CEUS特征不是HCC的特有表现，还需结合肝炎背景、肿瘤标记物、CT及MRI等影像学检查，必要时穿刺活检确诊。 |
| 关键词: 肝脏局灶性病变 超声造影 肝细胞肝癌 误诊 |
| DOI： |
| 投稿时间：2016-10-11修订日期：2017-01-01 |
| 基金项目:国家自然科学基金青年科学基金项目 |
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| Cases analysis of contrast-enhanced ultrasonography misdiagnosed as primary hepatocellular carcinoma |
| tangxiaofeng,XU Zuo-feng |
| (the Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University,) |
| Abstract: |
| Objective To summarize the contrast-enhanced ultrasound (CEUS) features of focal liver lesions which were misdiagnosed as primary hepatocellular carcinomas (HCC), and to analyze the reasons of misdiagnosis, in order to improve the diagnostic value of CEUS. Methods 132 patients with 198 focal liver lesions underwent CEUS scanning during June 2014 to October 2015. The terminal diagnoses of these lesions were confirmed by pathological and clinical diagnoses. The diagnostic efficacy of CEUS was calculated, and the reasons of misdiagnosis were summarized and analyzed. Results 28 patients without the final diagnosis were excluded. 104 patients with 138 leisions were made definite pathological and clinical diagnosis. 49 patients with 57 lesions were confirmed as HCC, and The corresponding sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosing HCC by CEUS were 91.23%（52/57）, 90.12%(73/81), 86.67%（52/60）, 93.59%（73/78）and 90.58%(125/138). 55 patients with 81 lesions were confirmed as other lesions, and the misdiagnosis rate of CEUS was 9.9 %（8/81）In total, 8 patients with 8 lesions were misdiagnosed as HCC by CEUS. All lesions were confirmed pathologically by percutaneous biopsy with ultrasound-guidance (n=3) and resection (n=5). All the misdiagnosed lesions showed hyper-enhancement or iso-enhancement during arterial phase and hypo-enhancement during portal or delayed phase. Conclusion Hyper or iso-enhancement during arterial phase and washout during portal or delayed phase are not particular CEUS features for HCC lesions history of hepatitis, level of tumor markers, and CT or MRI images were needed to be considered. Furthermore, in some cases the accurate diagnosis was still a real medical challenge so that a percutaneous liver biopsy was needed. |
| Key words: Focal liver lesions Contrast-enhanced ultrasound Hepatocellular carcinoma Misdiagnosis |
