肝局灶性病变超声造影增强时间及模式的临床意义

Clinical significance of enhancement time and patterns on contrast-enhanced ultrasonography in diagnosis of focal liver lesions

目的探讨肝局灶性病变(FLL)超声造影增强时间及模式的临床意义。方法对121例FLL进行超声造影检查,将其超声表现进行整理与归纳,分析其造影增强时间(开始时间、峰值时间、消退时间)及增强模式。结果121例FLL患者中,肝细胞性肝癌(HCC)表现为"快进快出",整体增强者82.5%(52/63),大部分增强11.1%(7/63),消退缓慢6.3%(4/63);肝血管瘤表现为向心性增强85.7%(18/21),快速增强14.3%(3/21,瘤体直径≤20mm);转移性肿瘤(MLC)呈快速环形边周增强,快速消退72.7%(8/11),瘤体始终不增强27.3%(3/11);局灶性结节性增生(FNH)表现为中央至整个瘤体的增强75.0%(3/4);肝脓肿和肝内胆管癌全部表现为环形增强;肝硬化增生结节和局灶性脂肪肝均表现为与肝组织同时增强及消退,且强度一致。结论超声造影增强时间及模式与肿瘤的血供特点关系密切,超声造影对肝局灶性病变的定性诊断有较大的临床意义。

Objective To evaluate the enhancement time and patterns on contrast-enhanced ultrasonography （CEUS） in diagnosis of focal liver lesions （FLL）. Methods One hundred and twenty-one cases with FLLs were examined with real-time gray-scale CEUS. Data were collected and analyzed retrospectively in terms of wash-in time, peak time, wash-out time and enhancement pattern. Results In total 121 cases of FLL, Hepatocellular carcinoma （HCC） lesions showed as fast wash-in and fast wash-out, of which 82.5%（52/63） showed as total enhancement and 11.1%（7/63） showed as most enhancement and 6.3%（4/63）showed as slow washing out. In 21 cases of haemangioma, 85.7%（18/21） showed as centripetal bolus-like enhancement while 14.3%（3/21）showed as fast enhancement with the diameter less than 20 mm. 72.7%（8/11）of metastatic liver carcinoma （MLC） enhanced as peripheral nodular hyper-enhancement pattern and fast wash-out; while 27.3%（3/11）showed no enhancement at all. 75.0%（3/4）of focal nodular hyperplasia （FNH） were centrifugal bolus-like enhancement. Liver abscess and interhepatic cholangiocarcinoma （ICC） all showed centripetal bolus-like enhancement. All the cirrhotic regenerative nodular and focal liver fatty enhanced the same as normal liver tissue. Conclusion The enhancement pattern and time of FLL are closely correlated with the tumor arterial supply, and contrast-enhanced ultrasound is useful in diagnosis of FLLs.