肝癌超声造影时间窗及影响因素分析

Clinical study on time-window about contrast-enhanced ultrasound of primary hepatocellular carcinoma

目的：探讨肝癌超声造影时间窗及影响因素。方法：经左肘静脉注造影剂SonoVue 2．4mL后，分别以肝动脉、门脉主干或二、三级分支显影作为动脉相、门脉相的开始，肝实质回声增强这峰值视为实质相的开始。结果：肝癌超声造影开始强化时间8～26s，平均（13．57±4．21）s，开始消退时间20-80s，平均（35．52±13．91）s，持续强化时间10～66s，平均（21．97±12．62）s。各时相出现的早晚及持续时间的长短，主要与肿瘤主供血管的性质及流入血管间或流入血管与流出血管间有无短路有关。以动脉供血为主的肝癌，动脉相快速强化，门脉相消退，谊表现见于大多敷肝癌。以门静脉供血为主者，动脉相、门脉相均强化，至实质相方消退，该现象见于肝癌。动门瘘时可使动脉相缩短，门脉相提前显影。结论：以相关血管显影作为时相的起始及时段，较能全面反映肿瘤特征，有助于定性诊断。主供血管的性质将影响时相的起始及长短。

Objeetive To investigate the time window of the contrast-enhanced ultrasound and the influence factors. Methods SonoVue 2.4 mL was iniected through the left elbow vein. The beginning of the main, second and third branches of hepatic artery or portal venous enhancement were defined as the artery phase or portal venous phase began respectively. The beginning of delayed phase was defined as the echo of liver parenchyma became lightest. Results The appearing time of contrastenhanced ultrasound of hepatocellular carcinoma was 8 to 26 s,wlth an average of （13.57±4.21） s. The disappearing time was 20 to 80 s,with an average of （35.52±13.91） s. The enhanced during time was 10 to 66 s,with an average of （21. 97±12.62） s. The appearing time and duration in each phase depended on the quality of inflow or outflow vessels and whether there is a shunt between the vessels. Artery phase enhanced fast and portal venous phase disappeared in the hepatocellular carcinoma fed mainly on artery. It was observed in most hepatocellular carcinoma. Artery phase and portal venous phase enhanced and PP disappeared in the hepatocellular carcinoma fed mainly on portal vein. It was observed in small hepatocellular carcinoma. Shorted artery phase and advanced portal venous phase were observed in hepatocellular carcinoma which appeared arterial-portal venous shunt. Conclusion Defining the relevant vessels enhancement as the beginning and during of the phase can reflect the hepatocellular carcinoma characteristic on the whole. It is helpful to diagnosis the nature of the tumor. The beginning and the length of the phase are influenced by the nature of mainly feeding vessel.