儿童恶性肿瘤患者肝脏病变的对比增强超声检查。

IF 3.5 2区 医学 Q2 ONCOLOGY Cancer Imaging Pub Date : 2024-08-29 DOI:10.1186/s40644-024-00750-3
Ayatullah G Mostafa, Zachary Abramson, Mina Ghbrial, Som Biswas, Sherwin Chan, Himani Darji, Jessica Gartrell, Seth E Karol, Yimei Li, Daniel A Mulrooney, Tushar Patni, Tarek M Zaghloul, M Beth McCarville
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引用次数: 0

摘要

背景:接受过癌症治疗的患者出现肝脏局灶性病变的几率高于普通人群,人们往往担心是恶性病因所致。这可能会导致患者、护理人员和医生的焦虑,根据临床担忧程度,他们会采取 "等待和观察 "的方法,或立即进行额外的影像学检查或活检。由于造影剂增强超声(CEUS)是一种低成本、易获取、无辐射、无镇静剂的检查方式,因此我们研究了造影剂增强超声(CEUS)在准确区分儿童恶性肿瘤患者肝脏良恶性病变方面的价值:我们进行了一项经 IRB 批准的回顾性研究,研究对象为 68 名新近确诊、正在接受治疗或停止治疗的儿童恶性肿瘤患者,他们在 CT、MRI 或非对比超声检查中发现肝脏病变,随后在 2013 年 9 月至 2021 年 9 月期间接受了 CEUS 检查。两名经验丰富的儿科放射科医生和一名放射科实习生对肝脏病变的病因学进行了盲法处理,他们独立审查了CEUS检查结果,并将病变分为良性、不确定或恶性。19例病变的参考标准是活组织检查,49例病变的参考标准是临床随访。仅使用良性和恶性 CEUS 分类计算 CEUS 的灵敏度、特异性、阳性和阴性预测值以及诊断准确性。通过 Cohen's kappa 统计学评估了审稿人之间的一致性:受试者中有 26 名男性和 42 名女性,平均年龄为 14.9 岁(1-52 岁不等)。50名受试者已停止治疗,12名受试者正在接受治疗,6名受试者是新诊断的癌症患者。根据参考标准,59 例(87%)病变为良性,9 例(13%)为恶性。三位审查员对 CEUS 的敏感性介于 83-100% 之间(95% CI,35.9-100%),特异性介于 93.1-96.0% 之间(95% CI,83.5-99.6%),PPV 介于 60.0-71.4% 之间(95% CI,29.0-96.3%),NPV 介于 98.0-100% 之间(95% CI,89.2-100%),准确性介于 93.8-94.6% 之间(95% CI,85.1-99.7%)。两位经验丰富的放射科医生之间的一致性卡帕统计为 0.58,属于中等水平:CEUS能高度准确地区分小儿恶性肿瘤患者肝脏病变的良性和恶性病因。
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Contrast enhanced ultrasound of liver lesions in patients treated for childhood malignancies.

Background: Patients treated for cancer have a higher incidence of focal liver lesions than the general population and there is often concern for a malignant etiology. This can result in patient, caregiver and physician anxiety and is managed by a "wait and watch" approach, or immediate additional imaging, or biopsy, depending on the degree of clinical concern. Because it is a low-cost, easily accessible, radiation and sedation free modality, we investigated the value of contrast enhanced ultrasound (CEUS) to accurately distinguish benign from malignant liver lesions in patients treated for childhood malignancies.

Methods: We performed an IRB approved retrospective study of 68 subjects who were newly diagnosed, on treatment or off treatment for a pediatric malignancy and had liver lesions discovered on CT, MRI or non-contrast ultrasound and subsequently underwent CEUS between September 2013 and September 2021. Two experienced pediatric radiologists and a radiology trainee, blinded to the etiology of the liver lesions, independently reviewed the CEUS examinations and categorized lesions as benign, indeterminate, or malignant. The reference standard was biopsy for 19 lesions and clinical follow-up for 49. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of CEUS were calculated using only the benign and malignant CEUS classifications. Inter-reviewer agreement was assessed by Cohen's kappa statistic.

Results: There were 26 males and 42 females, mean age, 14.9 years (range, 1-52 years). Fifty subjects were off therapy, twelve receiving treatment, and six with newly diagnosed cancer. By the reference standard, 59 (87%) lesions were benign and 9 (13%) were malignant. Sensitivities of CEUS for the three reviewers ranged from 83 to 100% (95% CI, 35.9-100%), specificities from 93.1 to 96.0% (95% CI, 83.5-99.6%), PPV 60.0-71.4% (95% CI, 29.0-96.3%), NPV 98.0-100% (95% CI, 89.2-100%) and accuracy from 93.8 to 94.6% (95% CI, 85.1-99.7%). The kappa statistic for agreement between the two experienced radiologists was moderate at 0.58.

Conclusions: CEUS is highly accurate in distinguishing benign from malignant etiologies of liver lesions in patients treated for pediatric malignancies.

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来源期刊
Cancer Imaging
Cancer Imaging ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
7.00
自引率
0.00%
发文量
66
审稿时长
>12 weeks
期刊介绍: Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology. The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include: Breast Imaging Chest Complications of treatment Ear, Nose & Throat Gastrointestinal Hepatobiliary & Pancreatic Imaging biomarkers Interventional Lymphoma Measurement of tumour response Molecular functional imaging Musculoskeletal Neuro oncology Nuclear Medicine Paediatric.
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