超声造影对慢性乙型肝炎患者肝组织纤维化分级的诊断价值

目的探讨应用超声造影评价肝纤维化的价值。方法选择慢性乙型肝炎患者80例及健康对照人群10例,经肘静脉团注超声造影剂SonoVue,记录造影剂到达肝动脉时间(HAAT)、到达门静脉时间(PVAT)及到达肝静脉时间(HVAT),计算造影剂到达肝动脉与到达肝静脉间隔时间(HAVTT)。结果 S3和S4期肝纤维化组HVAT和HAVTT均较对照组、S1期组缩短(P<0.05);以肝纤维化达到S4期为阳性判断标准,HVAT和HAVTT的ROC曲线下面积分别为0.87和0.89(P<0.01);以HVAT≤21s为诊断S4期肝纤维化的截断点,其敏感性为88%,特异性为95%;以HAVTT≤10s为诊断S4期的截断点,其敏感性和特异性分别为90%和97%;联合两项指标评估S4期的敏感性和特异性分别为98%和100%。结论超声造影对S3和S4期肝纤维化具有一定的定量诊断价值,但对诊断≤S2期的肝纤维化在准确性方面仍存在不足。

Evaluation of hepatic fibrosis in patients with chronic hepatitis B with contrast-enhanced ultrasound

Objective To explore the value of contrast-enhanced ultrasonography in diagnosis of liver fibrosis in patients with chronic hepatitis B.Method 80 patients with chronic hepatitis B and 10 healthy persons were recruited in this study.The ultrasound contrast agent,SonoVue,was injected through cubital vein,then the hepatic artery arrival time(HAAT),portal vein arrival time(PVAT) and hepatic vein arrival time(HVAT) were recorded,and the interval time between hepatic artery arrival time and hepatic vein arrival time(HAVTT) was calculated.Result HVAT and HAVTT shorten in hepatic fibirosis S3 and S4(P<0.05);the areas under ROC curve of HVAT and HAVTT were 0.87 and 0.89,respectively,for the diagnosis of hepatic fibrosis S4(P<0.01);When HVAT≤21s as the cut-off value for diagnosis of hepatic fibrosis S4,the sensitivity was 88%,the specificity was 95%;when HAVTT≤10s as the cut-off value for diagnosis of hepatic fibrosis S4,the sensitivity was 90%,the specificity was 97%.Conclusion Contrast-enhanced ultrasonography has some value in diagnosis of obvious hepatic fibrosis,but it might skip over some mild hepatic fibrosis in patients with chronic hepatitis B.