肝转移癌超声造影临床应用研究

Clinical study of liver metastasis by contrast-enhanced ultrasonography

目的探讨肝转移癌超声造影检出能力、造影增强时相特点并定量分析。方法35例肝转移癌患者为研究对象,行超声造影检查。动态观察动脉相（8～30s）、门脉相（31～120s）及实质相（121～360s）灌注和回声变化规律。记录病灶大小、位置、数目、各增强时相的表现。用QontraXt定量分析软件行量化分析。结果①35例肝转移癌常规超声共检出病灶182个,超声造影共检出386个,超声造影检出明显增加（P〈0.05）。②动脉相重点观察的76个肝转移癌病灶表现四种灌注特征Ⅰ型（26.3%）,周边环状增强,中心不增强或有少量点状、短线状血管向中心伸延。Ⅱ型（46.1%）,周边环状增强,内部少量均匀增强。Ⅲ型（11.8%）,周边环状增强,内部少量增强,可见细长分枝状血管。Ⅳ型（15.8%）,快速整体团状增强,内部团状或网状走行血管。③对四种增强类型行定量分析,峰值强度Ⅰ型低于其他三型,Ⅳ型高于其他三型（P〈0.05）;达峰时间Ⅳ型短于其他三型（P〈0.05）,曲线下面积Ⅳ型高于其他三型（P〈0.05）。④35例中重点观察的76个病灶门脉相和实质相均呈现不同程度低回声,其中实质相共有22例54个病灶与相邻肝组织对比非常明显呈“黑洞”现象。结论超声造影增加了肝转移癌病灶的检出数目;肝转移癌增强模式及造影表现有利于其定性诊断;定量分析有利于解释各增强类型的形成基础。

Objective To evaluate capabilities of contrast-enhanced ultrasound （CEUS） in detection of liver metastasis and to investigate the perfusion and echogenicity of liver metastasis using contrast tuned imaging （CnTI）. Methods Thirty-five patients with known liver metastasis were evaluated by conventional ultrasound and CnTI gray-scale ultrasound respectively. The perfusion patterns of liver metastasis were evaluated. QontraXt software was used to analyze the hemodynamic parameters （peak, TP, sharpness and AUC）. Results In 35 patients, 182 liver metastases were found by conventional ultrasound, 386 liver metastasis were found by CEUS. During the arterial phase, the perfusion patterns of 76 major investigated lesions were in four types. 26.3% enhanced in rim-like and the central region was defected; 46.1% enhanced in rim-like and the inside region was homogeneous enhancement but was hypoechoic; 11.8% enhanced in rim-like and tortuous vessels were detected in the lesion; 15.8% bolus-enhanced quickly and was hyperechonic. A significant difference （P〈0.05） was found in the values of peak, TP and AUC between the type of bolus-enhanced and other three types. In portal vein phase and late phase, all 76 lesions of 35 patients were hypoechoic in relation to the surrounding parenchyma. Conclusion CnTI markedly improve the detection of liver metastasis. The enhancement patterns of liver metastasis is helpful to characterization. Quantitative analysis of the perfusion of liver metastasis is helpful to explain the reason of the enhancement patterns.