灰阶超声造影对复发性肝癌的诊断价值

The role of gray-scale contrast-enhanced ultrasonography in the diagnosis of recurrent hepatocellular carcinoma

目的评价灰阶超声造影检查对复发性肝癌的诊断价值.方法对复发性肝癌46例与肝血管瘤20例、肝局灶性结节性增生16例,采用SonoVue行灰阶超声造影检查.所有病例均经手术或超声引导下穿刺活检病理证实.结果造影后82例肝肿瘤性病变均表现不同程度的增强.复发性肝癌多表现为快速消退型,如以快速消退型作为复发性肝癌的诊断指标,则超声造影诊断复发性肝癌的敏感性、特异性及准确性分别为93.5%、100%和96.3%,与肝血管瘤的自周围向中心结节样快速或缓慢充填,并呈持续增强型明显不同,同样与肝局灶性结节性增生多表现为动脉相快速自中心向外周放射状的持续增强也明显不同.结论灰阶超声造影对复发性肝癌的诊断有较高的敏感性、特异性及准确性.复发性肝癌由于肝内解剖与病理的特点造成其部分病例超声造影表现不典型,可能与其血流动力学及生物学特性有关,值得深入研究.

Objective To evaluate the value of gray-scale contrast-enhanced ultrasonography in the diagnosis of recurrent hepatocellular carcinoma （HCC）. Methods Eighty-two patients, including 46 patients with recurrent HCC, 20 with hepatic hemangioma （HCH） and 16 with focal nodule hyperplasia （ FNH）, were examined by gray-scale contrast-enhanced ultrasound with an intravenous administration of So- no Vue （a contrast medium）. The diagnoses of all the cases were confirmed by surgical findings or ultra- sound-guided aspiration biopsy. Results After injection of Sono Vue, different lesions showed different enhancement patterns. Most recurrent HCC lesions were enhanced quickly in early artery phase and disap- peared quickly in portal vein phase and late phase, which was regarded as a characteristics index of recurrent HCC. According to the index, the sensitivity, specificity and accuracy in the diagnosis of recurrent HCC with gray-scale contrast-enhanced ultrasonography were 93.5% （43/46）, 100% （36/36） and 96. 3% （79/82）, respectively. HCH presented nodule-like enhancement in artery phase with progressive centripetal filling, and the enhancement lasted throughout the whole portal vein phase and late phase. It was longer than that of recurrent HCC. A tortuous spoke-like vascularization from center to periphery was seen in most of liver FNH, and their enhancement lasted the whole portal phase and most of late phase, which was different from that of recurrent HCC. Conclusions Contrast-enhanced ultrasound can improve the diagnostic sensitivity, specificity and accuracy of recurrent HCC. We consider that the characteristics of contrast-enhanced ultrasound examination of recurrent HCC are related to its hemodynamics as well as its biological characteristics, which need further study.