Objective: To investigate the accuracy and safety of ultrasound-guided puncture biopsy and enhanced MRI in the diagnosis of alpha-fetoprotein (AFP) negative liver occupying lesions. Methods: Retrospective analysis was conducted on the clinical data of 59 patients with liver occupying lesions who were admitted to the Fifth Medical Center of the PLA General Hospital from February 2015 to November 2017 and received ultrasound-guided coarse needle biopsy with AFP negative. Among them, 35 cases were males and 24 cases were females, the age range was from 25 to 67 years,with an average age of (51±3) years. Serum AFP in all patients were within the normal range. The difference between the pathological results of ultrasound-guided biopsy and the diagnosis of lesions by enhanced MRI was compared, and the diagnostic value of ultrasound-guided biopsy was analyzed. Meanwhile, complications during and after puncture were recorded. SPSS 24.0 software was used for statistical analysis.The measurement data were expressed as x±s and enumeration data were expressed as rate,if the P value was less than 0.05, it indicated that the difference was statistically significant. Results: There were 32 malignant cases and 27 benign cases based on the final pathological diagnosis. The sensitivity and specificity of ultrasound-guided needle biopsy were 100%, in contrast, the enhanced MRI was 96.9% and 81.5%, respectively, with the former significantly higher than the latter. There were no abdominal bleeding,infections and pneumothoraxduring and after the puncture. Conclusion: Ultrasound-guided puncture biopsy and enhanced MRI are both safe for the diagnosis of AFP negative liver occupying lesions,but the former is more sensitive than the latter.When the clinical symptoms of the patient are relatively mild and there is uncertainty in the diagnosis due to the lack of specific enhanced imaging, ultrasound-guided puncture is more conducive to identifying the nature of the lesion.
目的： 探讨超声引导穿刺活检及增强MRI诊断在甲胎蛋白（AFP）阴性肝占位病变的准确性及穿刺的安全性。 方法： 回顾性分析2015年2月至2017年11月在解放军总医院第五医学中心超声科行穿刺活检AFP阴性的肝占位患者资料共59例，其中男35例、女24例，25~67（51±3）岁，血AFP在正常范围内，比较超声引导穿刺活检病理结果和MRI两者之间的差异，分析其诊断价值并记录穿刺术中及术后并发症发生情况。采用SPSS 24.0软件进行统计学分析，计量资料以x±s表示，计数资料用百分率表示，P<0.05为差异有统计学意义。 结果： 本组59例病例，其中恶性病变占54.2%（32/59），良性病变占45.8%（27/59），超声引导穿刺活检术的灵敏度、特异度均为100%，而增强MRI分别为96.9%和81.5%。穿刺术中及术后均未出现腹、盆腔出血、感染、气胸等严重并发症。 结论： 超声引导穿刺活检和增强MRI对诊断AFP阴性肝占位病变均安全，但超声更准确，当患者临床症状较轻且缺乏特异性、增强影像学诊断存在不确定性时，选择超声引导下穿刺更有利于明确病灶的性质。.
Keywords: Alpha-fetoproteins; Liver neoplasms; Magnetic resonance imaging; Ultrasonography, interventional.