超声造影在肝占位性病变诊断中的应用

The role of contrast-enhanced gray-scale ultrasound in the diagnosis of liver neoplasms

目的探讨超声造影剂声诺维(SonoVue)在不同肝占位性病变中超声造影特点。方法对30例原发性肝癌、17例转移性肝癌、8例肝血管瘤、7例肝局灶性结节增生、9例结节性肝硬化、1例炎性包块,共72例患者的肝占位性病变进行实时超声造影检查,并与彩色多普勒超声、增强CT及病理结果进行比较。结果经超声造影后,各种肝内占位性病灶均显示不同程度的增强特点。肝癌表现多为动脉相快速显影,门脉相快速消退,呈“快进快出”型；肝血管瘤动脉相时无明显变化,增强方式以门静脉期周边缓慢增强。呈向心样填充,即从周边向中心部持续充填,造影剂显影持续时间较长；肝转移癌动脉相为均匀性增强或周边环状增强,内部可有轻度点状增强改变,实质期迅速出现回声减弱改变,易发现微小病灶；肝局灶性结节增生也为动脉期迅速增强,表现为门静脉期保持呈持续增强改变,以中央扩散型的均匀持续增强为主,在延迟相中有明显的造影剂摄取。结论不同的肝占位性病变在实时超声造影能表现出不同的时相特点,超声造影有助于提高对肝肿瘤超声诊断的特异性、敏感性及准确性。

Objective To investigate the characteristics of the contrast agent SonoVue in gray-scale ultrasound in various liver neoplasms and to evaluate its value in the diagnosis of hepatic tumor. Methods Real-time contrast-enhanced ultrasound was performed in 72 patients with space-occupying lesions of the liver, including 30 cases of primary hepatic carcinoma, 17 of metastatic hepatic carcinoma, 8 of hepatic hemangioma, 7 of focal nodular hyperplasia （ FHN）, 9 of liver nodular cirrhosis and 1 of inflammatory mass. In all of them, the results were compared with those of color Doppler ultrasound, enhanced CT and pathologic examinations. Results After injection of SonoVue, all the lesions were variously enhanced on real-time ultrasonography. Specifically, a holistic inhomogeneous enhanced pattern with quick appearing of arterial phase and quick disappearing of portal phase was mostly detected in hepatic carcinoma; a slow peripheral and centripetal enhanced pattern of the portal vein with relatively long display of contrast agent was mostly shown in hemangioma; the enhancement pattern of metastatic hepatic carcinoma was diverse, ineludlng even or peripheral enhancement in the arterial phase with internal spotty enhancement, the echo was weakened rapidly in portal phase and the focus were discovered easily; and a radial centrifugal enhanced pattern with homogeneity of the portal phase was quickly observed in FNHS with an obvious intake of the contrast agent during the delay phase. Conclusions The dynamic enhanced fashions and various enhanced features in different hepatic tumors can be reflected by real-time contrast-enhanced ultrasound, which improves the accuracy, sensitivity and specificity of ultrasonography in the diagnosis of liver tumors.