超声造影在肝脏占位性病变诊断中的应用研究

Study of contrast-enhanced ultrasound in diagnosis of focal liver lesions

目的探讨实时超声造影对肝占位性病变的诊断价值。方法对89例患者共106个肝脏占位性病变进行实时超声造影研究,所有病例均与增强CT对照并经手术和病理证实。其中原发性肝癌23例,胆管癌2例,转移性肝癌11例,血管瘤21例,局灶性结节增生9例,局灶性脂肪缺失16例,肝硬化增生结节7例。造影剂选用SonoVue,浓度为8μL/mL,经肘部浅静脉快速推注。结果106个病灶均有不同程度的增强,肝癌动脉相表现为整体快速增强,并在门脉相快速消退,在实质相显示为低回声;血管瘤呈周围向心性环状或结节状增强,门脉相及实质相进一步增强,持续较长时间;局造性结节增生表现为中央扩散型快速整体增强,部分病例显示为车轮状;肝硬化增生结节与局灶性脂肪缺失的造影增强特征与肝实质一致。结论实时超声造影能显示肿瘤内微小血管的血流灌注情况,对肝脏占位性病变的定性诊断具有重要的意义。

[Objective] To evaluate the value of real-time contrast enhanced ultrasound in diagnosis of focal liver lesions. [Methods] Eighty-nine patients with 106 focal liver lesions were examined by contrast enhanced ultrasound, all cases were confirmed by histopathology and correlated with finding at contrast-enhanced CT. lesions included 23 hepatocellular carcinoma, 2 cholangiocellular carcinoma, 11 metastatic lesions, 21 hemangioma, 9 focal nodular hyperplasia（FNH）, 16 focal fatty sparing, 7 regenerative nodule. The contrast agent used was SonoVue （Bracco, Italy）. [Results] After injection of SonoVue, 106 focal liver lesions were various enhanced, hepatocellular carcinomas showed a typical hypervascular pattern in the arterial phase and rapid wash-out in the portal phase. A peripheral and centripetal enhanced pattern was mostly shown in hemangiomas, a pattern of a radial centrifugal enhanced in the very early arterial phase and a central stellate fibrous scar in portal phase was observed in FNHs for focal fatty sparing and regenerative nodule, a pattern of enhancement similar to the surrounding parenchyma was observed. [Conclusions] Contrast enhanced ultrasonography can show microvascular organization and parenchymal perfusion, it is very useful for differentiating among the focal liver lesions.