摘要目的 探讨肝细胞癌(HCC)超声造影(CEUS)定量灌注分析拟合质量(QOF)的影响因素以及定量分析的可重复性.方法 回顾性对136例HCC的CEUS图像进行定量灌注分析,获得周边肝实质、肿瘤和瘤内最高增强区的峰值强度(Imax)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(mTT)和QOF,根据QOF将拟合质量分为“满意”(QOF＞ 75％)、“基本满意”(QOF 50％ ～75％)和“不满意”(QOF＜ 50％)三组.比较三组间超声仪器型号、患者年龄及肿瘤部位、大小和深度的差异.由两位医生分别独立对连续20个病灶进行CEUS定量灌注分析,由同一位医生对连续20个病灶于不同时间进行CEUS定量灌注分析,应用组内相关系数评价检查者之间及检查者内部的可重复性.结果 肿瘤定量分析质量“满意”56个、“基本满意”38个、“不满意”42个.三组间病灶直径(P=0.015)、病灶位置(P=0.041)比较差异均有统计学意义,＞3.0 cm组和病灶位于远离膈肌的肝段(S3、S4b、S5、S6)定量分析质量较满意.超声仪器型号、患者年龄以及病灶深度在不同组间差异无统计学意义(均P＞0.05).周围肝实质各定量分析参数、肿瘤各定量分析参数以及瘤内最高增强区Imax、RT及TTP的检查者之间及检查者内部组内相关系数均＞0.9,重复性均为好;瘤内最高增强区mTT的检查者之间及检查者内部组内相关系数分别为0.459、0.609,重复性分别为差和一般.结论 HCC定量灌注分析参数在周围肝实质及肿瘤可重复性好,但瘤内最高增强区的mTT可重复性差;病灶大小和部位是定量分析质量的影响因素,病灶＞3.0 cm以及位于肝S3、S4b、S5、S6时定量分析质量较满意.

abstractsObjective To investigate the influencing factors of quality in contrast-enhanced ultrasound (CEUS) perfusion analysis for hepatocellular carcinoma (HCC) and the reproducibility of using CEUS perfusion analysis on HCC.Methods A total of 136 HCC lesions were undergone CEUS perfusion analysis.Maximum intensity (Imax),rise time (RT),time to peak (TTP),mean transit time (mTF) and quality of fit (QOF) of HCC lesion,top-enhanced region inside HCC lesion and adjacent liver parenchyma were measured.The quality of perfusion analysis was classified into three grades " Good" (QOF ＞ 75％),"Common" [QOF (50％-75％)],and " Poor" (QOF ＜ 75％).Ultrasound machine,patients' age,tumor depth,tumor size and tumor location were recorded and compared among the three groups.20 consecutive patients with 20 HCC lesions were received CEUS perfusion analysis by two operators and another 20 consecutive HCC lesions were received CEUS perfusion analysis by one operator at different time.Intra-class correlation coefficient (ICC) was used to evaluate the reproducibility of inter-and intra-observer.Results Fifty-six HCC lesions were classified as " Good",39 as " Common" and 39 as " Poor",respectively.Tumor size (P =0.015) and tumor location (P =0.041) were significantly different among the three groups.Tumor size ＞ 3.0 cm and tumor located in S3,S4b,S5,S6 were apt to gain a better QOF.No significant difference was found for the different ultrasound machine,tumor depth and patients' age.For all CEUS perfusion analysis parameters of both lesion and adjacent parenchyma,intra-class correlation coefficient of inter-and intra-observer were higher than 0.90,the reproducibility of CEUS perfusion analysis was good.For Imax,RT and TTP in top-enhanced region inside HCC lesion,ICC of inter-and intra-observer was all higher than 0.90 (good).For mITT in highest enhanced area inside HCC lesion,ICC of inter-and intra-observer were 0.459 (poor),0.609 (common),respectively.Conclusions The parameters of HCC quantitative perfusion analysis were reproducible in peripheral liver parenchyma and tumor,but the mTT repeatability was poor in the highest enhancement area of the tumor.The size and location of the lesion were the factors affecting quantitative analysis.The quantitative analysis of ＞ 3.0 cm and the tumor located in S3,S4b,S5,S6 in the liver were satisfactory.