發(fā)布時間：2018-01-20 10:53

  本文關(guān)鍵詞： 肝癌 造影劑 對比增強(qiáng)超聲 增強(qiáng)CT　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的本研究主要目的:探討CEUS(對比增強(qiáng)超聲)與CECT(對比增強(qiáng)計算機(jī)斷層掃描技術(shù))診斷肝癌灶大小的可靠性(直徑3.0cm或3.0cm~5.0cm或5.0cm),旨在明確兩種影像學(xué)檢查方法對癌腫病灶大小診斷的準(zhǔn)確性,進(jìn)而為臨床治療方案提供指導(dǎo)性意見。臨床資料回顧性研究分析2013年6月至2016年6月我院所收治的外科手術(shù)切除標(biāo)本經(jīng)病理組織學(xué)證實的肝癌患者197例(所有患者病灶均是單發(fā)病灶,術(shù)前均行CEUS與CECT檢查)。其中男性患者104例,女性患者93例,年齡22~70歲,中位年齡為52歲。腫瘤術(shù)后大體標(biāo)本的最大徑1.0~8.0cm,平均最大徑(4.0±2.2)cm。CEUS與CECT檢查的時間差不超過7天,兩種影像學(xué)檢查方法距病理檢查的時間均不超過21天,癌腫直徑3~5cm 96例(甲組);癌腫直徑3.0cm 63例(乙組),直徑5.0cm 38例(丙組)。儀器與診斷方法彩色超聲診斷儀器Philips iU22多普勒超聲診斷儀,探頭頻率為2.5~5.0 MHz,具有對比脈沖序列(CPS)CEUS成像技術(shù)及實時諧波成像技術(shù)(MI),或者使用西門子Sequoia Acuson 512多普勒超聲診斷儀,凸陣探頭,探頭頻率為1.0-4.0MHz,并具有CPS的CEUS成像技術(shù)。超聲造影劑采用的是六氟化硫微泡(聲若維)。CECT使用的是美國GE公司生產(chǎn)的VCT 64排螺旋計算機(jī)斷層掃描儀,造影劑選用的是碘克沙醇。1)CEUS:檢查方法:患者先行常規(guī)彩超腹部檢查,確定病灶位置、大小、形態(tài)、界限等;然后開始超聲造影,取0.9%生理鹽水5ml溶解造影劑凍干粉,震蕩混勻后用注射器抽取2.4ml,經(jīng)肘靜脈彈丸式方式注入,并用5ml 0.9%氯化鈉溶液沖管。注射造影劑的同時,在造影模式條件下啟動彩色多普勒超聲診斷儀內(nèi)置計時器及內(nèi)置錄像記錄,實時動態(tài)觀察病灶組織造影全過程(全程持續(xù)6min),然后逐幀分析造影圖像。造影診斷結(jié)果由兩名高年資超聲醫(yī)生獨(dú)立閱片分析,做出病灶性質(zhì)及大小的診斷,如果診斷結(jié)果不一致,則請主任醫(yī)師共同閱讀分析做出診斷。ceus在肝臟中的全過程可分為3個時相:動脈相(0~30s),門脈相(31~120s),延遲相(121~360s)。2)cect:檢查前患者禁食禁水8h以上,先行上腹部平掃后,再行增強(qiáng)掃描,造影劑是經(jīng)肘靜脈采用高壓注射器注射。cect造影劑是碘克沙醇(威視派克)。增強(qiáng)診斷結(jié)果是由兩名醫(yī)生共同分析完成(若兩人診斷結(jié)果相差較大,則再請主任醫(yī)師閱讀分析并做出診斷)。cect在肝臟中的全過程可分為3個時期:動脈期、門脈期、平衡期。結(jié)果1病理組織學(xué)確診的197例肝癌病變組織,其中原發(fā)性肝癌182例(肝細(xì)胞癌182例),肝內(nèi)膽管細(xì)胞癌3例,繼發(fā)性肝癌12例。甲組:原發(fā)性肝癌95例(肝細(xì)胞癌95例),繼發(fā)性肝癌1例;乙組:原發(fā)性肝癌54例(肝細(xì)胞癌54例),繼發(fā)性肝癌9例;丙組:原發(fā)性肝癌33例(肝細(xì)胞癌33例)膽管細(xì)胞癌3例,繼發(fā)性肝癌2例。1.1基礎(chǔ)病史甲組:95例肝細(xì)胞癌病灶,合并肝炎病史89例(肝炎肝硬化63例),合并脂肪肝病史5例,1例無任何基礎(chǔ)病史;1例繼發(fā)性肝癌病灶合并慢性萎縮性胃炎病史(病理提示原發(fā)灶來源于胃)。乙組:54例原發(fā)性肝癌病灶,合并有肝炎病史50例(肝炎肝硬化48例),合并有脂肪肝病史2例,2例無任何基礎(chǔ)病史;9例繼發(fā)性肝癌病灶,(病理提示病理提示5例原發(fā)灶來源于胃,4例原發(fā)灶來源于結(jié)腸);丙組:36例原發(fā)性肝癌病灶,合并有肝炎病史33例(肝炎肝硬化31例),3例無任何基礎(chǔ)病史;1例15年前行結(jié)腸癌根治術(shù)后(病理提示原發(fā)灶來源于結(jié)腸),1例繼發(fā)性肝癌病灶(病理提示病理提示原發(fā)灶來源于胃)。1.2肝癌病灶ceus與cect增強(qiáng)表現(xiàn)及測量本研究中原發(fā)性肝細(xì)胞癌病灶ceus多呈現(xiàn)“快進(jìn)快出”表現(xiàn),即動脈相病灶整體呈球狀快速增強(qiáng),門脈相早期開始廓清(增強(qiáng)與廓清時間明顯早于周圍肝組織)即“快進(jìn)快出”;肝內(nèi)膽管細(xì)胞癌及轉(zhuǎn)移性肝癌病灶CEUS呈現(xiàn)“快進(jìn)更快出”表現(xiàn),即動脈相病灶呈樹枝狀快速增強(qiáng),動脈相開始廓清,時間更快于HCC。原發(fā)性肝癌病灶CECT大多數(shù)也呈現(xiàn)“快進(jìn)快出”表現(xiàn),即動脈期高增強(qiáng)、門脈期等增強(qiáng)、延遲期低增強(qiáng),少數(shù)成像“快進(jìn)慢出”表現(xiàn),即動脈期及門脈期高增強(qiáng),延遲期等增強(qiáng);轉(zhuǎn)移性肝癌病灶CECT呈現(xiàn)“快進(jìn)更快退”表現(xiàn)。CEUS與CECT測量病灶大小時,多方位多角度觀察后,每位診斷醫(yī)生均獨(dú)立分析圖像完成后,選取病灶界限清晰,橫截面最大的圖像作為所測量的病灶最大徑(CEUS一般取腫瘤最大面時間段測定腫瘤的大小;CECT一般在靜脈相測定腫瘤大小)。2.CEUS與CECT在197例肝癌病灶大小的受試患者工作特征曲線(ROC)下面積分別為0.774、0.706,二者整體差異無統(tǒng)計學(xué)意義(P0.05)。3.甲組:CEUS特異度為80.6%-85.8%,敏感度73.2%-91.6%,CECT特異度為65.1%-77.2%,敏感度63.2%-85.3%。CEUS與CECT方法檢查診斷準(zhǔn)確率分別為97.9%(94/96)和89.6%(86/96),兩種檢查方法的結(jié)果差異具有統(tǒng)計學(xué)意義(P0.05);乙組:CEUS與CECT檢查方法診斷準(zhǔn)確率分別為90.4%(57/63)和87.3%(55/63),兩種檢查方法的結(jié)果差異無統(tǒng)計學(xué)意義(P0.05);丙組:CEUS與CECT檢查方法診斷準(zhǔn)確率分別為94.7%(36/38)和97.3%(37/38),兩種檢查方法的結(jié)果差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論CEUS與CECT對肝癌病灶大小的測量均有較大的臨床應(yīng)用價值,但是對于直徑3~5cm的病灶CEUS優(yōu)于CECT,同時CEUS還具有無創(chuàng)、便攜、無輻射和重復(fù)性好等優(yōu)點(diǎn),不僅可用于治療方案制定,還可對肝癌的大小在治療前后的對比有重要價值。因此綜合患者自身及臨床治療方案的制定等多方面考慮,對于肝癌病灶大小的測量優(yōu)先選擇CEUS檢查具有更高的應(yīng)用價值。
[Abstract]:Objective the purpose of this study is: To investigate CEUS (contrast enhanced ultrasound (CECT) and contrast enhanced computed tomography) reliability diagnosis of HCC tumor size (diameter of 3.0cm or 3.0cm~5.0cm or 5.0cm), aims at two kinds of imaging methods for cancer diagnosis accuracy of lesion size, so as to provide guidance for clinical treatment retrospective analysis of clinical data. Surgery from June 2013 to June 2016 in our hospital were 197 patients with hepatocellular carcinoma by histopathology confirmed cases of resected specimens (all patients were single lesions, underwent CEUS and CECT examination before surgery). 104 cases of male patients, 93 female patients, aged 22~70 years old, median age for 52 years. After the tumor resection specimens of the largest diameter 1.0~8.0cm, average maximum diameter (4 + 2.2) cm.CEUS and CECT examination of the time difference is not more than 7 days, from the pathological examination of two imaging methods Check the time not more than 21 days, the tumor diameter of 3~5cm in 96 cases (Jia Zu); tumor diameter 3.0cm 63 cases (group B), the diameter of 5.0cm in 38 cases (Bing Zu). Instruments and diagnostic methods of color ultrasonic diagnostic instrument Philips iU22 Doppler ultrasound probe frequency of 2.5~5.0 MHz, with contrast pulse sequence (CPS) CEUS imaging and real-time harmonic imaging (MI), or the use of SIEMENS Sequoia Acuson 512 Doppler ultrasound diagnostic apparatus, convex array probe, probe frequency of 1.0-4.0MHz, CEUS and CPS. The imaging technology of ultrasound contrast agent is used six sulfur hexafluoride microbubbles (sound Ruowei) the use of the.CECT is produced by GE company of America VCT 64 slice spiral CT scanner, the contrast agent is iodixanol.1) CEUS: examination: the patients underwent routine ultrasound examination of the abdomen, to determine the location, size, shape, boundary; then contrast-enhanced ultrasound, 0.9% students Physiological saline 5ml contrast agent dissolved freeze-dried powder, mixing with injection syringe after shock 2.4ml through elbow vein bolus injection, and 5ml 0.9% Sodium Chloride Solution tube. The injection of contrast agent at the same time, start the color Doppler ultrasonic diagnostic apparatus and video recording in the built-in timer built-in contrast mode under the condition of dynamic real-time observation of the whole process of lesions tissue contrast (full 6min), and then the frame analysis contrast image. Contrast analysis of diagnosis results by two senior doctors to make independent ultrasound diagnosis, lesion properties and the size, if not the diagnosis results, please make a diagnosis analysis of chief physician to read.Ceus in the liver of the whole process can be divided into the 3 phase: the arterial phase (0~30s), portal vein (31~120s), delayed phase (121~360s).2) cect: patients before the examination of fasting 8h above the first scan of the upper abdomen, and then underwent enhanced scan, contrast agent is 緇忚倶闈欒剦閲囩敤楂樺帇娉ㄥ皠鍣ㄦ敞灝，

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