摘要
目的 通过观察超声造影对肝硬化背景下增生结节的灌注过程及回声变化规律，探讨增生结节的造影模式，并评价超声造影对肝硬化增生结节的诊断价值。方法 采用SonoVue实时灰阶超声造影，观察78例肝硬化合并占位病变及小结节195灶。最终确诊41例48灶肝细胞癌合并增生结节83灶，37例为单纯性肝硬化增生结节64灶；以147灶增生结节为研究对象。47例92灶在超声造影后30～60min内行穿刺活检确诊，余31例55灶增生结节经临床以及影像诊断随访6个月以上，并行多次血清甲胎蛋白检查确诊。比较增生结节造影前后诊断率。结果 超声造影增生结节呈四种灌注模式：模式一，61灶（41．5％），动脉期、门脉期及实质期与肝呈同步灌注；模式二，31灶（21．1％），为延迟增强，其后与肝同步；模式三，46灶（31．3％），主要显示为实质期轻度退出；模式四，9灶（6．1％），为各期均无灌注。超声造影前43．5％（64／147）难以定性或考虑为恶性，造影后根据动脉期无明显增强，实质期无明显退出的诊断标准，96．6％（142／147）可明确排除恶性。造影前后诊断率差异有统计学意义（P〈0．05）。结论 对肝硬化背景下增生结节超声造影增强模式的认识大大提高了肝内增生结节的定性诊断率，超声造影可作为肝硬化患者合并小结节病变的有效筛选手段。
Obtective To observe the enhancement pattern and the change of echogenicity of regenerative nodules（RNs） in cirrhotic patients and to evaluate the diagnostic value on the cirrhotic RNs by contrast-enhanced ultrasound（CEUS）. Methods One hundred and ninety-five focal liver lesions or small nodules in 78 cirrhotic patients were examined using SonoVue by real time gray-scale CEUS. Eighty-three RNs in 41 patients coexisted with 48 lesions of hepatocellular carcinoma （HCC）. Thirty-seven cases with 64 RNs were simplex cirrhosis. One hundred and forty-seven RNs were chiefly observed and were enrolled. Ninty-two RNs in 47 cases were confirmed by biopsy within 30 - 60 minutes after CEUS; others（55 RNs in 31 cases） were followed up by clinical or imaging methods for more than 6 months and were examined serum AFP for several times. Results The enhancement patterns were classified as the following four types： Type Ⅰ, 61 lesions（41.50%）, enhanced simultaneously and presented the isoecho with the liver in arterial, portal and parenchymal phase; Type Ⅱ, 31 lesions（21.1%）, presented delayed enhancement in portal phase and then became the isoecho in parenchymal phase; Type Ⅲ, 46 lesions（31.3%） slightly washed out and presented hypo-echo in parenchymal phase;; Type Ⅳ, 9 lesions （6.1%） presented hypoechoic or echo-free without perfusion in each phase. Before CEUS, 43.5 % （64/147） of lesions could not be diagnosed as benign or malignant. After CEUS, 96.6% （142/147） of lesions could be exclude malignancies according to diagnostic standard of no enhancement in arterial phase and no obviously washing out in parenchymal phases. There was a statistically significant difference in the diagnostic rate before and after CEUS（ P 〈0. 05）. Conclusions The enhancement patterns of RNs provided a reliable way for differential diagnosis between benign and malignant of small nodules in the liver cirrhosis. The CEUS will become an effective method to follow up the cirrhotic patients.
出处
《中华超声影像学杂志》
CSCD
2006年第4期293-296,共4页
Chinese Journal of Ultrasonography
基金
北京市科委重大项目培育专项(Z0005190040431)
北京大学医学部"十五""211工程"重点学科建设项目经费资助(523)
关键词
超声检查
造影剂
肝硬化
增生结节
Ultrasonography
Contrast media
Liver cirrhosis
Regenerative nodule
