彩色多普勒能量图观察肝硬化癌变过程滋养血流的变化

Sequential hemodynamic change associated with hepatocarcinogenesis complicating cirrhosis evaluated by power Doppler sonography

目的探讨肝硬化癌变过程的滋养血流特征及其鉴别诊断价值。方法运用彩色多普勒能量图显像(CDE)研究肝硬化合并9例大再生结节(LRN)、31例增生不良结节(DN)和37例小肝癌(SHCC)显像特征,并与CT增强扫描进行对比。结果CDE的血流检出率在LRN组、DN组和SHCC组分别为11%、48%和81%,具有统计学差异(P<0.01);SHCC组相对灌注率明显高于DN组,而低分化SHCC组相对灌注率明显大于高分化组。DN和SHCC组以及高低分化SHCC两组多普勒频谱构成均具有统计学差异(P<0.01)。87%由CDE检测到有滋养肝动脉血流的SHCC在增强CT动脉期表现为高密度信号。结论CDE可以反映肝硬化癌变过程血供特点和演变过程,对临床鉴别诊断具有重要价值。

Objective To evaluate the characteristics of feeding vessels and their usefulness in differentiating various nodes during hepatocarcinogenesis complicating cirrhosis. Methods Sixty-three patients with cirrhosis underwent color Doppler energy (CDE) and contrast-enhanced CT imaging. Nine large regenerative nodules (LRN), 31 dysplastic nodules (DN) and 37 small hepatocellular carcinomas (SHCC) were included in this study. Results Intratumoral blood flow was detected in 11% LRN, 48% DN and 81% SHCC by CDE (P<0.01).The relative perfusion rate was significantly higher in SHCC than DN, the same as in poor differentiated SHCC than well differentiated SHCC. The constitution of pulsed Doppler waves is different between DN and SHCC, well and poor differentiated SHCC. Eighty-seven percent SHCC detecting feeding hepatic artery appeared high intense signal in contrast-enhanced CT. Conclusion CDE can detect the hemodynamic characteristics and evolving process during hepatocarcinogenesis complicating cirrhosis and proved to be of great importance in differential diagnosis.