摘要
目的 评估超声造影(CEUS)和增强CT在布-加综合征(BCS)及其亚型中的诊断价值,探求该疾病在不同亚型临床诊疗中优选的影像学检查方案.方法 对63例BCS患者在常规超声检查基础上行CEUS和增强CT检查,以DSA结果作为金标准,通过受试者工作特征(ROC)曲线下面积(AUC)评价不同影像学方法对BCS的诊断效能;通过计算真阳性率、真阴性率、准确度、阳性预测值、阴性预测值比较两种影像学技术在BCS不同亚组之间的诊断能力.结果 ①通过ROC曲线,超声的AUC为0.776,CEUS的AUC为0.822,超声联合CEUS的AUC为0.835,增强CT的AUC为0.748.②在肝静脉型中:CEUS诊断的真阳性率、真阴性率、准确度、阳性预测值、阴性预测值分别是80.00％、63.64％、73.08％、75％、70％;增强CT诊断的真阳性率、真阴性率、准确度、阳性预测值、阴性预测值分别是66.67％、33.33％、50％、50％、50％.③在下腔静脉型中:CEUS诊断的真阳性率、真阴性率、准确度、阳性预测值、阴性预测值分别是87.5％、100％、92.86％、100％、85.71％;增强CT诊断的真阳性率、真阴性率、准确度、阳性预测值、阴性预测值分别是88.89％、75.00％、84.62％、88.89％、75.00％.④在混合型中:CEUS诊断的真阳性率、真阴性率、准确度、阳性预测值、阴性预测值分别是95.24％、85.71％、92.86％、95.24％、85.71％;增强CT诊断的真阳性率、真阴性率、准确度、阳性预测值、阴性预测值分别是95.65％、50.00％、86.21％、88.00％、75.00％o结论 对比研究CEUS与增强CT诊断BCS及其亚型的价值,CEUS有着更高的诊断效能,推荐CEUS作为BCS临床诊疗中首选的增强影像学检查方法.
Abstract
Objective To evaluate the diagnostic value of contrast-enhanced ultrasonography(CEUS)and contrast-en-hanced CT in the diagnosis and treatment of Budd-Chiari syndrome(BCS)and its subtypes,and to explore the optimal ima-ging protocols for the clinical diagnosis and treatment of different subtypes of this disease.Methods Sixty-three patients with suspected BCS were examined by CEUS and contrast-enhanced CT.The results of digital subtraction angiography(DSA)were used as the gold standard.The diagnostic efficacy of different imaging methods in BCS was evaluated by the area under the curve(AUC).The diagnostic ability of the two imaging techniques in different subgroups of BCS was compared by calcu-lating true positive rate,true negative rate,precision rate,positive predictive value and negative predictive value.Results①According to the ROC curve,the AUC of ultrasound was 0.776,CEUS being 0.822,combined ultrasound and CEUS be-ing 0.835,and contrast-enhanced CT being 0.748.②In the hepatic vein subtype,the true positive rate,true negative rate,precision rate,positive predictive value and negative predictive value of CEUS diagnosis were 80.00％,63.64％,73.08％,75％and 70％,respectively.The true positive rate,true negative rate,precision rate,positive predictive value and negative predictive value of the contrast-enhanced CT were 66.67％,33.33％,50％,50％,and 50％,respectively.③In the inferior vena cava subtype,the true positive rate,true negative rate,precision rate,positive predictive value and negative predictive value of CEUS diagnosis were 87.5％,100％,92.86％,100％and 85.71％,respectively.The true positive rate,true neg-ative rate,precision rate,positive predictive value and negative predictive value of enhanced CT were 88.89％,75.00％,84.62％,88.89％,75.00％,respectively.④In the mixed subtype,the true positive rate,true negative rate,precision rate,positive predictive value and negative predictive value of CEUS were 95.24％,85.71％,92.86％,95.24％and 85.71％re-spectively.The true positive rate,true negative rate,precision rate,positive predictive value and negative predictive value of enhanced CT were 95.65％,50.00％,86.21％,88.00％and 75.00％,respectively.Conclusions Compared with con-trast-enhanced CT in the diagnosis of BCS and its subtypes,CEUS has higher diagnostic efficacy,and it is recommen-ded as the preferred imaging method in the clinical diagnosis and treatment of Budd-Chiari syndrome.
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