实时超声造影检测肝血管瘤的临床研究

Real-time contrast-enhanced ultrasonography in the diagnosis of liver haemangiomas

目的探讨肝血管瘤超声造影增强模式,检测肝血管瘤的血流动力学特点。方法应用实时超声造影匹配成像技术(CnTI)与超声造影剂声诺维(SonoVue)对76例90个肝血管瘤病灶患者行造影超声检查,所有病灶均经增强CT或MRI证实,其中1例经穿刺活检,3例经手术病理证实。动态观察肝血管瘤注射造影剂后在动脉期(0-40s)、门脉期(41-120s)及延迟期(121-360s)灌注变化规律,并用QontraXt定量分析软件对90个肝血管瘤进行量化分析。结果注射造影剂后血管瘤开始增强时间为10-18s,平均(13.3±2.5)s,90个病灶均在动脉期出现增强,在门脉期和延迟期持续向心性填充,延迟期病灶持续强化。其中27个(30.0%)病灶在动脉期呈周边结节状强化,随后进行性向心性填充,39个(43.3%)病灶为环状强化,24个(26.7%)病灶在动脉期呈整体快速强化,门脉期和延迟期呈持续等高回声。病灶大小与动脉期、门脉期、延迟期病灶的增强模式有关,体积较大的血管瘤多呈结节状强化,体积较小者以整体快速强化多见(P<0.05)。肝血管瘤三种增强模式(结节状强化、环状强化、整体快速强化)与正常肝组织时间-强度比较:灌注峰值高、曲线下面积大、曲线陡、整体快速强化组达峰值时间短,结节状强化组、环状强化组达峰值时间缓慢,整体快速强化组灌注峰值大于其他两组,曲线的尖度整体强化组与环状强化组均比结节状强化组陡,曲线下面积三组比较均有差异。结论肝血管瘤增强模式为动脉期从周边结节状、环状或整体快速强化开始,门脉期和延迟期持续向心性进行性增强;实时超声造影可以敏感地显示肝血管瘤的动态增强过程,揭示肝血管瘤的血流动力学特点。

Objective To explore the ultrasonographic perfusion and enhancement pattern of liver haemangiornas, and its hemodynamic characteristics. Methods Seventy-six patients （90 lesions of liver haemangiomas）underwent contrast-enhanced ultrasound examination by using real-time gray-scale contrast tuned imaging technology （CnTI） and SenoVue. All heamangiomas were confirmed by typical contrast-enhanced CT and/or MRI, 1 case with needle biopsy and 3 with surgeries. The hemodynamic perfusion characteristics were oKserved at arterial phase （0 -40 s）,portal phase （41 - 120 s）and delay phase （121 -360 s）,and were qualitatively analyzed by using QontraXt software. Results The contrast-enhancement time of liver heamangiomas was 10 - 18 s [average （13.3 ± 2.5） s ] after bolus injection of SenoVue. All 90 lesions were enhanced at arterial phase, and persistently enhanced at portal and delay phase. Of 90 lesions, 27 （30.0 % ）showed peripheral hyperechoic nodules at arterial phase and followed by progressive centripetal fill-in, 21 complete and 6 incomplete ; 39 （43.3 % ） showed a peripheral hyperechoic ring of arterial contrast enhancement with progressive and complete centripetal fill-in at portal and delay phases; 24 （26.7%） showed rapid and complete enhancement, persisting at portal and delay phases. The enhancement pattern of liver haemangiomas at arterial, portal, and delay phase was related with the difference of lesion size： the larger haemangiornas showed peripheral hyperechoic nodule, and the smaller tended to fill-in rapidly and completely at arterial phase （P〈 0.05）. The enhancement patterns of liver haemangiomas was of higher peak value, larger area under curve and steeper curve than that of normal liver. The perfusion peak value in rapid and complete fill-in group was higher than that in peripheral hyperecboic ring group and peripheral hyperechoic nodule group. The curve sharpness in the rapid and complete fill-in group and peripheral hyperechoic ring group was steeper than that in peripheral hyperechoic nodule group. There was significant difference in curve areas between three groups. Conclusion The characteristic enhancement pattern of liver haemangioma is of peripheral hyperechoic nodules, or a peripheral hyperechoic ring, or rapid and complete enhancement at arterial phase, and of progressive centripetal fill-in at portal and delay phase. The real-time contrast-enhanced ultrasonography can sensitively demonstrate the dynamic enhancement of haemangiornas, and reveal the hemodynamic characteristics of haemangiomas.