肝局灶性病变超声造影:参照欧洲指南1015例临床报告

Contrast-enhanced ultrasound in focal liver lesions:summarization of a series experience with 1015 cases referred to European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines

目的评价欧洲医学和生物学超声协会联盟关于超声造影应用指南的作用和意义。方法采用造影剂SonoVue和低机械指数连续成像方法的超声造影技术,参照欧洲指南,总结鉴别诊断864例肝局灶性病变和监测151例局部消融治疗的经验。结果病灶动脉期呈现高或等增强、至延迟期消退为低或无增强,在良性病变中占16.6%(43/258),恶性肿瘤中为96.7%(522/540)(P=0.000)。以延迟期仍保持高或等增强、或3个时相均无增强判定为良性病变,敏感性86.3%(270/313),43例假阴性中炎性假瘤、炎性肉芽肿和肝脓肿占31例(72.1%)。以延迟期消退为低或无增强判定为恶性肿瘤,敏感性96.2%(530/551),21例假阴性全部为肝细胞性肝癌(21/444,4.7%)。超声造影判定消融治疗局部疗效的敏感性87.5%,特异性97.7%,准确性95.5%;检出局部复发的敏感性89.5%,特异性95.0%,准确性92.3%。结论欧洲指南是一个很好的指导超声造影应用的规范,值得重视和推荐使用,但对炎症类病变的增强规律还有待进一步总结补充。

Objective To evaluate the availability and significance of a guidelines for use of contrast-enhanced ultrasound （CEUS） advocated by European Federation of Societies for Ultrasound in Medicine and Biology （EFSUMB）. Methods An innovative CEUS technique, a set of sulphur hexafluoride-filled microbubble contrast agent（SonoVue） and continuous imaging method with low mechanical index, was used for characterization of focal liver lesion （FLL） in 864 cases and monitoring local ablation therapy in 151 cases. The results were summarized referring to EFSUMB guidelines. Results In lesions with hyper- or iso-enhancement during arterial phase then subsiding to hypo- or non-enhancement in late phase, the benign FLLs was 16.6% （43/258） whereas the malignant FLLs was 96.7% （522/540） （P = 0.000）. Estimation of benign lesions by a given criterion of persistent enhancement in late phase or never enhancing in all phases was 86.3 % （270/313） in sensitivity. Among 43 of false negative cases 31 （72.1%） were inflammatory disease. The sensitivity of estimation of malignant tumors by a given criterion of presenting low- or non-enhancement in late phase was 96.2% （530/551） and all of 21 false negative were hepatocellular carcinoma. In evaluation of response to ablation therapy with CEUS, the sensitivity, specificity and accuracy were 87.5%, 97.7% and 95.5%, respectively. With regard to detection of local recurrence the sensitivity, specificity and accuracy of CEUS were 89.5%, 95.0% and 92.3%, respectively. Conclusions EFSUMB guidelines is a good standard to instruct application of CEUS and deserves to be emphasized and recommended. The enhancement pattern of inflammatory disease should be further concluded and supplemented.