接受癌症治疗的患者的局灶性肝脏病变发生率高于一般人群，并且常常担心其恶性病因。这可能会导致患者、护理人员和医生焦虑，可以通过“等待和观察”方法或立即进行额外成像或活检来进行管理，具体取决于临床关注的程度。由于它是一种低成本、易于使用、无辐射和镇静的治疗方式，我们研究了超声造影 (CEUS) 在准确区分儿童恶性肿瘤患者的良性和恶性肝脏病变方面的价值。我们进行了一项 IRB 批准的回顾性研究2013 年 9 月至 2021 年 9 月期间，68 名新诊断、正在治疗或停止治疗的儿童恶性肿瘤受试者在 CT、MRI 或非对比超声中发现肝脏病变，随后接受了 CEUS。两名经验丰富的儿科放射科医生和一名放射学实习生对肝脏病变的病因不知情，独立审查了 CEUS 检查并将病变分类为良性、不确定或恶性。参考标准为19个病灶的活检和49个病灶的临床随访。仅使用良性和恶性CEUS分类来计算CEUS的敏感性、特异性、阳性和阴性预测值以及诊断准确性。采用Cohen's kappa统计评估审稿人间的一致性。其中男性26名，女性42名，平均年龄14.9岁（范围1-52岁）。五十名受试者停止治疗，十二名受试者正在接受治疗，六名受试者新诊断出癌症。根据参考标准，59 个（87%）病变为良性，9 个（13%）为恶性。三位评价者的 CEUS 敏感性范围为 83% 至 100%（95% CI，35.9-100%），特异性范围为 93.1% 至 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%），准确度从 93.8% 到 94.6%（95% CI，85.1-99.7%）。两位经验丰富的放射科医生之间一致性的 kappa 统计值为 0.58。CEUS 在区分儿科恶性肿瘤患者肝脏病变的良性和恶性病因方面非常准确。© 2024。作者。

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.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.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.CEUS is highly accurate in distinguishing benign from malignant etiologies of liver lesions in patients treated for pediatric malignancies.© 2024. The Author(s).