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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (06): 625 -628. doi: 10.3877/cma.j.issn.2095-3232.2022.06.018

临床研究

超声造影与MRI诊断肝泡型包虫病病灶生物学活性的一致性分析
邓旭1, 韩军伟1, 王晶晶1, 张灵强1, 杨小周1, 李钊1, 王海久1, 樊海宁1, 吕明德2, 阳丹才让1,†()   
  1. 1. 810000　西宁，青海大学附属医院肝胆胰外科　青海省包虫病研究重点实验室
    2. 510080　广州，中山大学附属第一医院超声科
  • 收稿日期:2022-08-08 出版日期:2022-12-10
  • 通信作者: 阳丹才让
  • 基金资助:
    青海省卫生计生委一般指导性课题项目(2018-wjzdx-118); 青海省包虫病临床医学研究中心项目(2017-SF-L2)

Diagnostic consistency between contrast-enhanced ultrasound and MRI for biological activity of hepatic alveolar echinococcosis

Xu Deng1, Junwei Han1, Jingjing Wang1, Lingqiang Zhang1, Xiaozhou Yang1, Zhao Li1, Haijiu Wang1, Haining Fan1, Mingde Lyu2, Cairang Yangdan1,†()   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qinghai University, Key Laboratory of Echinococcosis Research in Qinghai Province, Xining 810000, China
    2. Department of Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2022-08-08 Published:2022-12-10
  • Corresponding author: Cairang Yangdan
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目的

探讨超声造影（CEUS）与MRI诊断肝泡型包虫病（HAE）病灶生物学活性的一致性。

方法

本研究对象为2019年10月至2020年12月青海大学附属医院收治的47例HAE患者。患者均签署知情同意书，符合医学伦理学规定。其中男17例，女30例；平均年龄（36±2）岁。患者均在1周内分别行CEUS和MRI检查，分析其图像特点，评价病灶的生物学活性。采用Kappa检验分析CEUS增强模式与MRI小囊泡样结构对HAE病灶生物学活性诊断的一致性。

结果

47例患者CEUS共检查出77个病灶，62个病灶显示边缘增强，其中高增强19个，等增强15个，低增强28个。MRI按照矫正后Kodama分型，1型1个，2型20个，3型37个，4型17个，5型2个。MRI检出53个小囊泡样结构病灶具有生物学活性，CEUS检出62个，两种检查方式的一致性较好（κ=0.696，P<0.001）。

结论

CEUS与MRI诊断HAE病灶的生物学活性具有较好的一致性。与MRI相比，CEUS具有方便、易操作、经济等优势，可有效评估HAE病灶的生物学活性，随访HAE的病情变化。

关键词: 棘球蚴病，肝, 超声检查，介入性, 磁共振成像, 生物学活性
Objective

To assess the diagnostic consistency between contrast-enhanced ultrasound (CEUS) and MRI for hepatic alveolar echinococcosis (HAE).

Methods

47 patients with HAE admitted to the Affiliated Hospital of Qinghai University from October 2019 to December 2020 were recruited. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 17 patients were male and 30 female, aged (36±2) years on average. All patients received CEUS and MRI within 1 week. The imaging features were analyzed to assess the biological activity of lesions. The consistency between the enhancement pattern by CEUS and vesicle-like structure by MRI in the diagnosis of biological activity of HAE was analyzed by Kappa test.

Results

77 lesions were detected from 47 cases by CEUS. 62 lesions revealed peripheral enhancement including 19 lesions of hyperenhancement, 15 isoenhancement and 28 hypoenhancement. According to the revised MRI Kodama classification,1 lesion was classified as type 1, 20 lesions were type 2, 37 lesions were type 3, 17 lesions were type 4 and 2 lesions were types 5. 53 lesions with vesicle-like structures possessed biological activity were observed by MRI, and 62 lesions were detected by CEUS. The consistency between two imaging tools was high (κ=0.696, P<0.001).

Conclusions

CEUS and MRI yield high diagnostic consistency for the biological activity of HAE lesions. Compared with MRI, CEUS is more convenient, easy to operate and economical, and it can be utilized to effectively evaluate the biological activity of HAE lesions and monitor the changes of HAE during follow-up.

Key words: Echinococcosis, hepatic, Ultrasonography, interventional, Magnetic resonance imaging, Biological activity
图1 HAE病灶常规超声与CEUS对比注：a为HAE病灶周边无增强，b为HAE病灶周边明显增强；白色箭头所示为HAE病灶，HAE为肝泡型包虫病，CEUS为超声造影
图2 MRI显示HAE病灶矫正后Kodama分型注：a为1、2型，左侧白色小箭头示1型，中央白色大箭头示2型；b、c、d分别为3、4、5型；e为矫正后3型无小囊泡型；f为矫正后5型有小囊泡型；HAE为肝泡型包虫病，白色箭头所示为病灶
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