肝局灶性结节增生与肝血管瘤的超声造影鉴别

Differential diagnosis of hepatic focal nodular hyperplasia and hepatic hemangiomas by intravenous contrast enhanced ultrasonography

目的探讨超声造影对肝局灶性结节增生和肝血管瘤的清晰程度。方法经增强CT或MR对照,并经手术及病理证实的肝局灶性结节增生病变患者10例,肝血管瘤患者21例。采用第二代超声造影剂SonoVue进行低机械指数实时超声造影成像,记录肝实质及病灶的充填过程、充盈方式及增强程度。结果肝局灶性结节增生和肝血管瘤的造影模式各有其特点,其主要鉴别点在于病灶的充填过程及充填方式,10例肝局灶性结节增生动脉相均为快速增强,其中7例为中央型,3例为整体型,门脉相均为高回声,延迟相8例为高回声,2例为等回声;21例肝血管瘤,动脉相表现为周边环状增强,中央无增强,门脉相继续由周边环状或结节状向中央向心性增强,延迟相均呈整体增强。结论超声造影能清楚显示肝局灶性结节增生和肝血管瘤的造影充填过程及充填方式,对肝局灶性结节增生和肝血管瘤的鉴别诊断具有重要的意义。

Objective To study the clinical value of the intravenous contrast enhanced uhrasonography in differential diagnosis of hepatic focal nodular hyperplasia（FNH） and hepatic hemangiomas （HCH）. Methods Ten patients with FNH and 21 patients with HCH were enrolled in this study. The patients were diagnosed by histopathology and contrast-enhanced CT or MRI. Real- time intravenous contrast enhanced ultrasonography with low mechanical index was performed with SonoVue （the second generation contrast agent produced by Bracco in Italy）. The time courses, modes and intensities of contrast agent infusion were recorded and analyzed. Results The patients with FNH and HCH have significant differences in the filling modes and timing of contrast agents. Among the 10 FNH patients,7 of them showed fast central enhancement and 3 of them showed fast uniform enhancement in the arterial phase. In the portal phase,all FNH patients showed hyperechoic enhancement. In the delayed phase,8 FNH patients showed hyperechoic enhancement and 2 FNH patients showed mild hyperechoic enhancement. By comfurision, all the HCH patients showed peripheral enhancement in the artery phase, central-pedal filling patterns in the portal phase and uniform enhancement in the delayed phase, Conclusion Intravenous contrast enhanced ultrasonography provides important clinical information, including the dilution timing and modes, for differential diagnosis of FNH and HCH.