超声定位显微镜联合超声造影鉴别肝脏局灶性病变
这项前瞻性研究纳入68例患者共73个肝脏局灶性病变，评估超声定位显微镜（ULM）定量参数鉴别良恶性的价值。基于微血管密度比、灌注指数和平均微血管直径的ULM模型AUC为0.855，优于常规超声造影（CEUS）视觉评估的0.808；两者联合AUC提升至0.928，显著优于单独CEUS。
要点
- ULM定量参数（微血管密度比、灌注指数、平均微血管直径）可独立鉴别肝脏病变良恶性。
- ULM模型AUC 0.855，优于CEUS视觉评估的0.808。
- ULM联合CEUS可将AUC提升至0.928，提供形态与功能互补信息。
核心结论
- ULM定量参数能有效鉴别肝脏局灶性病变的良恶性，并在CEUS视觉评估基础上提供增量诊断价值。
- 联合CEUS与ULM可综合形态学和功能学信息，显著提高诊断效能。
研究设计与样本
- 前瞻性研究，纳入68例患者共73个肝脏局灶性病变（26个良性，47个恶性）。
- 患者接受CEUS和ULM成像，进行盲法CEUS视觉评估和ULM定量参数提取。
- 采用多因素分析筛选ULM模型预测因子，并通过ROC分析比较CEUS、ULM及联合方法的诊断效能。
关键影像表现/征象
- 恶性肝脏局灶性病变在微血管密度、血流速度、灌注指数、血管迂曲度和微血管直径等多个ULM定量参数上与良性病变存在显著差异（均p < 0.05）。
诊断标准与关键数值
- 多因素逐步逻辑回归识别出三个独立预测因子：微血管密度比百分比、灌注指数和平均微血管直径。
- 基于上述参数的ULM定量模型鉴别良恶性肝脏局灶性病变的AUC为0.855（95% CI: 0.768-0.942）。
- CEUS视觉评估的AUC为0.808（95% CI: 0.698-0.918）。
- ULM联合CEUS的AUC为0.928（95% CI: 0.868-0.988），显著优于单独CEUS（p < 0.001）。
临床应用与阅片要点
- 在日常阅片中，除CEUS视觉评估外，可关注ULM提供的微血管密度比、灌注指数和平均微血管直径等定量参数。
- 对于CEUS视觉评估难以定性的肝脏局灶性病变，联合ULM定量分析可能提高诊断信心。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: To investigate the value of quantitative parameters derived from ultrasound localization microscopy (ULM) in differentiating benign from malignant focal liver lesions (FLLs), and to evaluate its added diagnostic value compared with conventional contrast-enhanced ultrasound (CEUS) visual assessment.
METHODS: In this prospective study, patients with focal liver lesions underwent CEUS and ULM imaging. Blinded visual assessment of CEUS images and quantitative ULM parameter extraction were performed. Multivariate analysis identified predictors for a ULM model. Diagnostic performance of CEUS, ULM, and combined approaches was compared by ROC analysis.
RESULTS: The study included 68 patients with 73 lesions (26 benign and 47 malignant). Compared with benign lesions, malignant FLLs showed significantly different values for multiple ULM quantitative parameters, including microvessel density, flow velocity, perfusion index, vascular tortuosity, and microvessel diameter (all p < 0.05). Multivariate stepwise logistic regression identified three independent predictors: percentage of microvessel density ratio, perfusion index, and mean microvessel diameter. The ULM quantitative model based on these parameters achieved an AUC of 0.855 (95% CI: 0.768-0.942) for differentiating benign from malignant FLLs, outperforming CEUS visual assessment (AUC: 0.808; 95% CI: 0.698-0.918). Combining both approaches further improved the AUC to 0.928 (95% CI: 0.868-0.988), significantly better than CEUS alone (p < 0.001).
CONCLUSION: ULM quantitative parameters effectively differentiated benign from malignant FLLs, providing incremental diagnostic value beyond CEUS visual assessment. The combined approach offers comprehensive morphological and functional information, significantly improving diagnostic performance and serving as a promising complementary tool for clinical decision-making.
引用
- Li H, Niu X, Yang H, et al. Contrast-Enhanced Ultrasound With Ultrasound Localization Microscopy for Differentiating Benign From Malignant Focal Liver Lesions. Ultrasound Med Biol. 2026. PMID: 42185185. doi:10.1016/j.ultrasmedbio.2026.04.021
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。