彩色多普勒超声在肝内早期小感染灶与小肝癌鉴别诊断中的应用价值

Color Doppler sonography in differential diagnosis of small hepatic infective lesions and small hepatic carcinomas

目的探讨彩色多普勒超声对肝内早期小感染病灶及小肝癌的鉴别诊断价值。方法应用彩色多普勒超声对19例肝内直径≤3cm的早期感染病灶(细菌性肝脓肿10例、肝结核6例、肝霉菌2例、肝梅毒1例)和30例肿瘤直径≤3cm的小肝癌病灶的形态、边缘、内部回声、占位效应、血流特点等进行对比观察。所有病变的诊断均经活检病理证实。结果肝内早期小感染灶组中病灶形态不规则16例(16/19),小肝癌组中病灶形态不规则6例(6/30),两组病灶形态比较差异有统计学意义(P<0.05)。感染灶组中病灶边缘不清15例(15/19),小肝癌组中病灶边缘不清晰9例(9/30),两组比较差异有统计学意义(P<0.05)。感染灶组中病灶无明显占位效应19例(19/19),低回声16例(16/19),而小肝癌组中病灶无明显占位效应23例(23/30),低回声24例(24/30),以上两项结果两组间比较差异无统计学意义(P>0.05)。感染灶组和小肝癌组的血流信号检出分别为5例(5/19)和10例(10/30),两组比较差异无统计学意义(P>0.05),但是两组检出的穿支或环状血流信号分别为0例(0/19)及8例(8/30),差异有统计学意义(P<0.05)。结论彩色多普勒超声不仅可显示肝内早期小感染灶及小肝癌的病灶边缘、形态,还可更清晰显示病灶的血流特点,从而可对肝内早期小感染灶与小肝癌病灶进行更有效的鉴别诊断。

Objective To approach the application of color Doppler sonography in differential diagnosis of small hepatic infective lesions and small hepatic carcinomas. Methods Nineteen patients with small hepatic infective lesions (Ⅰ group)were studied, all the lesions were in the early stage and the diameters of all the lesions were <3 cm, including the hepatic bacterial abscess in 10, hepatic tubercular lesion in 6, hepatic fungal lesion in 2, hepatic syphilitic lesion in 1. Thirty patients with hepatic carcinoma (C group) of diameter <3 cm were also studied. All the cases were proved by pathology. Every patient was examined on color Doppler sonography. The difference of shape, edge, internal echoes, space-occupying effect and blood flow characteristics of lesions on ultrasonography in the two groups were compared. Results In the Ⅰ group, irregular shape was in 16 cases(16/19)and indefinite edge in 15(15/19)vs 6 cases(6/30)and 9(9/30), respecticvely in the C group, all (P<0.05) with significant difference.In I group, all the lesions had no space-occupying effect in 19(19/19) and 16 (16/19) were low internal echoes in nodi vs 23(23/30)and 24 (24/30)in the C group (P>0.05) , without significance. The blood flow signals were detected in 5 cases in I group and 10 cases in C group without significant difference (P>0.05). No perforating branch blood flow or round flow was found in I group, while it was found in 8 cases in C group (P<0.05), with significance difference. Conclusions Color Doppler sonography can display not only the edge and shape of lesions, but also the blood flow characteristics of the lesions, so it may be more effective in differential diagnosis of hepatic infective lesion in early stage and small hepatic carcinoma.