超声造影对肝硬化合并小肝癌的早期诊断价值

Early diagnosis of small hepatocellular carcinoma in patients with cirrhosis using contrast-enhanced ultrasound

目的观察肝硬化背景下不同组织类型小肝癌(≤3.0 cm)的超声造影灌注时间及增强模式,探讨超声造影对小肝癌的诊断价值.方法146例肝局灶性病变行超声造影,其中经手术或穿刺病理确诊肝硬化合并小肝癌(≤3.0 cm)42例48个病灶;记录分析48个病灶造影增强模式,并进行造影前后良恶性诊断5级评分比较.全部病例造影前、后半个月内行增强CT检查进行对比.结果造影后中～低分化肝癌38个病灶(79.2%)动脉期发生快速强化,实质期快速消退,呈'快进快出'型;6个高分化小肝癌呈'快进慢出'型;4个肝透明细胞癌中3个≤1.5 cm灶呈'慢进慢出'型,另1个 2.2 cm肿瘤呈'快进快出'型.造影前仅27个病灶(56.0%)超声作出正确诊断或诊断恶性倾向;造影后14个病灶(29.0%)评分提高2～4分,17个病灶仅提高1分.最终有2个病灶仍未能获得定性诊断,有4个病灶仅诊断恶性倾向,余42个病灶被确认恶性,诊断正确率达 87.5%(42/48灶). 结论灰阶超声造影对肝硬化背景下不同组织类型小肝癌增强模式的初步研究,可为小癌灶的早期诊断提供依据;作为CT等影像诊断的互补手段,超声造影可成为诊断肝硬化合并小肝癌灵敏可靠的方法.

Objective To investigate the perfusion and contrast enhancement patterns of small hepatocellular carcinoma (HCC) in cirrhotic livers for the role of contrast-enhanced ultrasonography (CEUS) in diagnosing small HCC in size less than 3 cm with different histological types.Methods One hundred and forty-six patients with focal liver lesions were referred to CEUS.Forty-eight small lesions in 42 patients were diagnosed pathologically as HCC by surgery or needle biopsy.A diagnostic score of 1 to 5 was given to each lesion before and after contrast injection.Contrast-enhanced CT was performed in all the cases within 15 days of CEUS.Results Following contrast administration,38( 79.2%) moderately to poorly differentiated HCC lesions presented with fast early arterial phase enhancement and then a quick wash-out in the parenchymal phase.Six well-differentiated HCC lesions had a contrast-enhancement pattern of “fast-in and slow-out”.Three of 4 clear cell carcinomas with the size of ≤ 1.5 cm had an enhancement pattern of “slow-in and slow-out”.Another clear cell carcinomas of 2.2 cm in size showed “fast-in and fast-out” pattern.Before CEUS,only 27 lesions ( 56.0%) were definitely or tentatively diagnosed as malignant lesions.After CEUS,the diagnostic scores of14 HCC lesions ( 29.0%) were increased 2-4 points,while 17 lesions increased 1 points.Forty-two lesions were correctly diagnosed as malignant,while 2 lesions could not be diagnosed as benign or malignant and 4 lesions were diagnosed as malignant tentatively.The diagnostic accuracy of CEUS was 87.5% (42/48 lesions).Conclusions The contrast enhancement patterns of small HCC with different histological types in CEUS were useful for early diagnosis of small malignancies.CEUS might be an alternative method to other imaging techniques,such as CT to diagnose small HCC in cirrhotic patients.