小儿皮肤皮下血管瘤的超声诊断:增生期或退化期的判断

Study on color Doppler ultrasound differential diagnosis between proliferating hemangioma and involuting hemangioma in children

目的探讨婴幼儿皮肤软组织增生期和退化期血管瘤的彩色多普勒超声特征。方法对32例(37个肿瘤)经病理证实为血管瘤的彩色多普勒超声表现进行回顾性分析。并根据Ki-67免疫组化结果分为增生期和退化期血管瘤,比较二者的彩色多普勒超声特征、动脉收缩期峰值血流速度(PASV)、阻力指数(RI)。结果增生期血管瘤(24个):声像图表现为混合回声团块,血流通过静脉网、或小动静脉瘘时形成丰富的彩色血流信号,频谱多普勒探查为动静脉血流信号,动脉血流频谱为低阻力型;PASV=(64.31±27.80)cm/s,RI=0.54±0.11。退化期血管瘤(13个):有较多的纤维化、钙化成分导致血管腔隙闭合,声像图主要表现为高回声型,彩色血流信号较稀疏;PASV=(39.23±22.18)cm/s,RI=0.69±0.12。增生期血管瘤PASV、RI和退化期血管瘤比较,P<0.01。结论增生期血管瘤和退化期血管瘤彩色多普勒超声有一定差异,对婴幼儿皮肤软组织血管瘤的诊断与分期具有重要的临床意义。

Objective To explore the value of color Doppler ultrasound differential diagnosis between proliferating hemangioma and involuting hemangioma in children.Methods The feature of color Doppler ultrasound of 24 cases proliferating hemangioma and 13 cases involuting hemangioma in children proved by immunohistochemistry were retrospectively studied.Their high-resolution gray scale ultrasound characteristics,peak arterial systolic flow velocity and resistance index were examined and compared.Results Twenty-four cases proliferating hemangiomas appeared mix solid masses with inner network-like structures in high-resolution gray scale ultrasound features.CDFI revealed flashing red and blue color blood flow,venous signal with low velocity and arterial blood flow with high velocity and low resistance.On Doppler energy images,the blood flow signals were very rich and nice continuation forming vascular tree branches with network distribution.But the involuting hemangiomas were demonstrated as hyperechoic masses containing many calcifications and fibrosis in high resolution gray scale ultrasound.There was less red and blue color blood flow in masses.The peak arterial systolic flow velocity,resistance index were（64.31±27.80）cm/s,0.54±0.11 separately in proliferating hemangioma.In involuting hemangioma,the peak arterial systolic flow velocity,resistance index were（39.23±22.18）cm/s,0.69±0.12.Compared the peak arterial systolic flow velocity and resistance index of two group,the peak arterial systolic flow velocity and resistance index in proliferating hemangioma were significantly than those in involuting hemangioma（P〈0.01）.Conclusion The features of color Doppler ultrasound of proliferating hemangioma in children were obviously different from those of involuting hemangioma,which may play an important role in the diagnosis and the differential diagnosis of proliferating hemangioma and vascular malformation.