超声造影对患者肝移植术前肝脏局灶性病变的鉴别诊断价值

The differential diagnosis of focal lesions in cirrhotic liver before liver transplantation by contrast-enhanced ultrasound

目的利用超声造影技术鉴别诊断患者肝移植术前肝硬化并发局灶性病变的价值。方法对104例患者肝移植术前的158个病灶进行超声造影检查。结果33个硬化结节以门脉期整体等增强为主要特点;2个不典型增生结节表现为门脉期中央低增强、周围等增强;106个原发性肝细胞癌(HCC)病灶表现为动脉期高增强、门脉期及延迟期低或等增强,HCC低分化组较高分化组病灶内造影剂到达时间及达峰时间比自身肝实质明显提前(P<0.05);6个卫星病灶表现为三期低增强;3个肝脓肿病灶表现为动脉期及门脉期周边厚环状高增强;8个血管瘤病灶表现为三期整体或结节状向心性高增强。结论超声造影技术有助于肝移植术前肝硬化并发局灶性病变的鉴别诊断,为肝移植术前制定治疗方案提供帮助。

Objective To discuss the value of contrast-enhanced ultrasound in diagnosing focal lesions in cirrhotic liver before liver transplantation. Methods One hundred and four patients with 158 focal lesions were examined by contrast-enhanced ultrasound （CEUS） using contrast agent SonoVue. Results Thirty-three regenerative nodules were characterized by iso-enhancement in portal phase; Two dysplastic nodules showed inner hypo-enhancement and peripheral annular iso-enhancement in portal phase; 106 hepatic cell carcinomas showed hyper-enhancement in arterial phase and hypo- or isoenhancement in portal or delay phase. AAT and ATTP were significantly increased in poorly differentiated group as compared with well differentiated group （P〈0. 05）; 6 metastasic lesions showed hypoenhancement in three phases; 3 hepatic abscesses showed peripheral thick-circular hyper-enhancement in arterial and portal phase; 8 hemangiomas were hyper-enhanced in three phases with wholly or centripetal nodular enhancement. Conclusion CEUS was beneficial to the differential diagnosis of focal lesions in cirrhotic liver before liver transplantation.