脉冲反向谐波实时超声造影与增强螺旋CT诊断肝占位病变的比较研究

Characterization of focal liver lesions using real-time pulse-inversion harmonic contrast-enhanced ultrasonography:comparison with contrast-enhanced helical CT

目的比较实时超声造影与增强螺旋CT显示肝占位病变血流灌注特点的能力,探讨超声造影在肝肿瘤鉴别诊断中的应用价值。方法对109例经手术或超声引导穿刺活检病理确诊的肝占位(原发性肝癌61例,转移性肝癌15例,肝内胆管细胞癌5例,血管瘤12例,肝硬化增生结节5例,肝细胞腺瘤2例,胆管细胞腺瘤1例,局灶性结节增生3例,局灶性坏死4例,血管平滑肌脂肪瘤1例)术前分别进行实时超声造影和造影剂增强16层螺旋CT检查,将两种检查的术前诊断与术后病理结果进行比较分析。结果超声造影漏诊原发性肝癌2例、转移性肝癌1例,误诊原发性肝癌5例、胆管癌1例、胆管腺瘤1例、肝硬化结节1例、血管瘤1例、局灶性结节增生1例。增强CT漏诊原发性肝癌3例、转移性肝癌2例、血管瘤1例、肝硬化增生结节1例,误诊原发性肝癌7例、胆管癌2例、胆管腺瘤1例、血管瘤3例、肝硬化结节2例、局灶性结节增生2例、局灶性坏死2例。超声造影诊断肝占位病变的检出率为97.25%,增强CT的检出率为93.58%;超声造影诊断肝肿瘤的准确性为90.83%,增强CT的准确性为82.57%。结论实时超声造影对肝占位病变的诊断能力与增强螺旋CT相近,实时超声造影具有独立诊断价值,对于增强CT扫描阴性或未显示病灶血流灌注特点的病例,超声造影具有更重要的临床意义。

Objective To compare the efficacy of real-time contrast-enhanced ultrasonography for characterization of focal liver lesions with contrast-enhanced helical CT. Methods Real-time pulse-inversion harmonic SonoVue enhanced ultrasonography and helical CT were performed on 109 patients with focal liver lesions （including 61 hepatocellular carcinomas, 15 liver metastasis, 5 cholangiocellular carcinomas, 12 hemangiomas, 5 regenerative nodules, 3 adenomas, 3 focal nodular hyperplasias, 4 focal necrosis and 1 angiomyolipoma）, and the diagnoses were made before operation or biopsy. The diagnostic performance was calculated by considering histologic results as the reference standards. Results Three cases were overlooked by contrast-enhanced ultrasonography and 7 cases were missed by enhanced helical CT. Ten cases were misdiagnosed by enhanced ultrasonography and 19 cases were misdiagnosed by enhanced helical CT. The detection rate of focal liver lesions was 97.25 % （106/109） for enhanced ultrasonography and 93.58 % （102/109） for enhanced helical CT （ P 〉0. 05）. The overall accuracy was 90. 83 %（99/109） for enhanced ultrasonography and 82.57% （90/109） for enhanced helical CT （P 〉 0.05）. Conclusions Real-time pulse-inversion harmonic SonoVue enhanced ultrasonography is at least comparable with enhanced helical CT in detection and characterization of focal liver lesions and has high diagnostic performance independent of enhanced helical CT.