| ObjectiveTo assess the value of real time gray scale contrast-enhanced ultrasonography in differentiating the liver disease by measuring the hepatic artery to vein transit time (HAVTT) and quantitative analyzing the time intensity curve (TIC) of liver parenchymal enhancement.Methods254 liver disease patients (inclued 86 chronic hepatitis B patients,42 patients with benign liver lesions, 28 patients with cirrhosis nodule, 48 patients suffered from hepatocellular carcinomas (HCC) without cirrhosis , 38 patients suffered from HCC with cirrhosis , 12 patients with metastases), 9 patients suffered from gastroenteric tumor without metastases and 20 normal volunteers in this hospital were involved in this study. Real time gray scale contrast-enhanced ultrasonography was used . After routine ultrasonic inspection, a bolus of SonoVue was injected into peripheral vein of these patients. HAVTT measurement and quantitative analyzing the TIC of liver parenchymal enhancement was performed then. All chronic hepatitis B liver disease cases were verified by pathology. In focal liver lesions (FLLs) group, 48 cases were verified by operation and biopsy, 52 cases were proved by CT enhancement, MRI and DSA, the rest were confirmed by AFP examination and follow-up. Measurement data was signed as mean±standard deviation (x_±s). ANOVA test was used to analyzed more than 2 groups measurement data. LSD test was used in multiple comparison and t test in 2 group. Correlation analysis used Spearman rank correlation analysis. ROC curve analysis was used to evaluate the diagnosis index and determine the threshold value. P<0.05 is consider as statistical significance. Results1. The differences among HAVTT values measured by four methods are unremarkable. Visualization of Real time gray scale contrast-enhanced ultrasound is the most successful measurement because of its least influencing factors.2. In chronic hepatitis B liver disease cases , HAVTT value has the shortened tendency with the higher fibrosis degree. HAVTT1 and HAVTT2 value has remarkable difference between S2 and S3 degree . HAVTT value shortened in higher G degree , the difference is remarkable . Respectively, making HAVTT1≤8 s,HAVTT2≤10 s as diagnostic criteria of cirrhosis, the accuracy, sensitivity, specificity, positive evaluation, negative evaluation, false positive rate, false negative rate was 83.91%, 79.2%, 89.7%, 90.5%, 77.8%, 9.5%, 22.2% and 82.76%, 83.3%, 87.2%, 88.9%, 81.0%, 11.1%, 19.0%. Making HAVTT1≥11 s,HAVTT2≥13 s as diagnostic criteria of none of fibrosis , the index was 73.91%, 84%, 68.2%, 60%, 88.2%, 40%, 11.8% and 82.61%, 88%, 79.5%, 71.0%, 92.1%, 29.0%, 7.9%. Making HAVTT1:(8.1～10.9)s,HAVTT2(:10.1～12.9)s as diagnostic criteria of fibrosis , the index was 78.16%, 61.4%, 95.3%, 93.1%, 70.7%, 6.9%, 29.3% and 79.31%, 63.6%, 95.3%, 93.3%, 71.9%, 6.7%, 28.1%.3.The liver essence suffered of chronic hepatitis B disease was perfused unevenly, especailly under liver capsule. In this area, perfusion has the shortened tendency with the higher fibrosis degree. And TP, PI, AUC, HTD value of quantitative analyzing the TIC of liver parenchymal enhancement has the shortened tendency with the higher fibrosis degree .4. HAVTT1 value has remarkable difference between benign space occupying lesion (SOL),cirrhosis nodule and malignancy space occupying lesion group of liver. Our study marked HAVTT1≤10 s as the differentiating diagnostic criteria of benign and malignancy SOL of liver, the accuracy, sensitivity, specificity, positive evaluation, negative evaluation, false positive rate, false negative rate was 76.51%, 78.50%, 71.43%, 87.5%, 56.60%, 12.5%, 43.40%.5. HAVTT1 values of gastroenteric tumor patients was significant shorter than patients without liver metastases (P<0.05). Our study marked HAVTT1≤10 s as the standard whether the patients with gastroenteric tumor have metastases in liver would have accuracy rate of 90.48% , sensitivity of 83.33%, specificity of 100%.Conclusions1. Visualization of Real time gray scale contrast-enhanced ultrasound has broader prospect of clinical application than ACQ curve method.2. HAVTT measurement and TIC analysis of liver parenchyma detected by real time gray scale CEUS with SonoVue can reflect the changes of hepatic microcirculation and hemodynamics in chronic liver disease patients. Those threshold values proposed in this study would be helpful to judge the hepatic fibrosis degree and to diagnose the hepatic cirrhosis in an early stage. HAVTT measurement and TIC analysis is promising to be new noninvasive index to diagnose the stage of chronic liver disease with the expansion of cases.3. Our study showed that the liver essence suffered of chronic hepatitis B disease was perfused unevenly because of different depth and part.And the extent has the aggravated tendency with the higher fibrosis degree. It claims that real time gray scale contrast-enhanced ultrasound is helpful to formulate clinical hepatic pricking program and to improve the quality of the sample.4.Our study marked HAVTT1≤10s as the standard to judge whether the patients with gastroenteric tumor have metastases in liver or not , which is less valuable than real time gray scale contrast-enhanced ultrasound. However , combination of the two methods would be helpful to enhance the ability of differential diagnosis about the benign and malignancy.5. Our study showed that HAVTT values mesured by real time gray scale contrast-enhanced ultrasound can be reference prediction index of whether the patients with gastroenteric tumor have metastases in liver. However, the duration was short , the cases was not enough and the self controlled study is still absent. The clinical value of this method will be further verificated with increasing cases and extending follow-up time. |
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