Natural history of postvascular-phase iso-enhanced lesions on the sonogram in chronic liver diseases
Natural history of postvascular-phase iso-enhanced lesions on the sonogram in chronic liver diseases
复制标题
慢性肝病超声图像上血管后期等增强病变的自然史
DOI：
10.1111/jgh.12449
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Yamaguchi T
中科院分区：
文献类型：
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作者：
Kondo T;Maruyama H;Sekimoto T;Shimada T;Takahashi M;Chiba T;Kanai F;Yokosuka O;Yamaguchi T
背景和目的本研究检查了超声造影后血管后等增强病变（PIEL）的自然史，以确定慢性肝病中发生肝细胞癌（HCC）的潜在风险和预测因素。（血管后阶段：注射全氟丁烷微泡后10分钟），72例慢性肝病患者（45例男性和27例女性;年龄65.0 ± 10.8岁; PIEL直径12.5 ± 4.2 mm）。PIELS随访超声/造影剂增强超声，计算机断层扫描，或磁共振成像在3至6个月intervention.ResultsTwenty患者发展HCC在研究期间（中位数，22.0个月）。1年时HCC发生的累积风险为7.9%，3年时为36.0%。同时存在HCC（风险比[HR]，4.975; 95%置信区间[CI]，1.729 - 14.316; P = 0.003）和甲胎蛋白> 20 ng/mL（HR，4.104; 95% CI，1.621 - 10.392; P = 0.003）是HCC发生风险的重要因素。这些病变中有14处被诊断为由等增强病变发展而来的HCC。PIEL> 14 mm的累积HCC发生率在1年时为23.5%，在3年时为46.3%。考克斯回归分析表明，PIEL> 14 mm（HR，6.780; 95% CI，2.060 - 22.32; P = 0.002）和甲胎蛋白> 20 ng/mL（HR，4.892; 95% CI，1.559 - 15.350; P = 0.007）是HCC发生的统计学显著因素。或PIEL> 14 mm应仔细监测，因为HCC发生的可能性很高。
Background and AimThis study examined the natural history of postvascular‐phase iso‐enhanced lesions (PIELs) on contrast‐enhanced sonograms to determine the potential risk and predictive factors for developing hepatocellular carcinoma (HCC) in chronic liver diseases.MethodsThis prospective study included 87 PIELs on contrast‐enhanced sonograms (postvascular‐phase: 10 min post‐injection of perflubutane microbubbles) in 72 patients with chronic liver diseases (45 males and 27 females; age 65.0 ± 10.8y; PIEL diameter 12.5 ± 4.2 mm). The PIELs were followed up by ultrasound/contrast‐enhanced ultrasound, computed tomography, or magnetic resonance imaging at 3 to 6 months intervals.ResultsTwenty patients developed HCCs during the study period (median, 22.0 months). The cumulative risk of HCC occurrence was 7.9% at 1 year and 36.0% at 3 years. The presence of coexistent HCC (hazard ratio [HR], 4.975; 95% confidence interval [CI], 1.729–14.316;P= 0.003) and alpha‐fetoprotein > 20 ng/mL (HR, 4.104; 95% CI, 1.621–10.392;P= 0.003) were significant factors for the risk of HCC occurrence. Fourteen of these lesions were diagnosed as HCCs that developed from iso‐enhanced lesions. Cumulative HCC occurrence rates from PIEL > 14 mm was 23.5% at 1 year and 46.3% at 3 years. Cox regression analysis showed that PIEL > 14 mm (HR, 6.780; 95% CI, 2.060–22.32;P= 0.002) and alpha‐fetoprotein > 20 ng/mL (HR, 4.892; 95% CI, 1.559–15.350;P= 0.007) were statistically significant factors for HCC occurrence.ConclusionsPatients with coexistent HCC, alpha‐fetoprotein > 20 ng/mL, or PIEL > 14 mm should be carefully monitored because of the high potential for HCC occurrence.