肝移植术后肝癌复发的二维超声及超声造影表现

Two dimensonal ultrasound and ultrasonic manifestation for tumor recurrence after liver transplantation

目的探讨肝移植术后复发性肝癌的二维超声、彩色多普勒超声及超声造影表现。方法对30例原位肝移植术后肝癌复发灶行常规超声及超声造影检查,对肝内多发病灶,超声造影选取其中最大的一个病灶进行观察。观察复发灶的位置、大小、形态、边界、内部回声、内部血流、周围血管及超声造影增强形态,分析与比较复发灶的二维超声、彩色多普勒超声及超声造影表现。结果肝移植术后1.3～42个月超声随访发现30例患者肝癌复发。其中肝内复发灶90个,肝周复发灶6个。复发灶形态呈椭圆形88个;低回声85个;内部回声不均匀76个;边界清楚68个;复发灶内探及动脉血流信号55个。30个肝内复发灶及6个肝周复发灶超声造影动脉期均表现为高增强,门静脉期均为低增强,均为"快进快出"的增强模式。结论肝癌肝移植术后可见肝内与肝周复发灶,肝内及肝周复发灶超声造影表现为"快进快出"的增强模式时应提示肝癌复发。

Objective To explore the ultrasonographic patterns of recurrent hepatocarcinoma after liv- er transplantation including the patterns of two-dimensional ultrasound, color Doppler and contrast-enhanced ultrasound （CEUS）. The largest lesion of multiple lesions in liver was observed by contrast-enhanced ultrasound. Methods Thirty patients with recurrent hepatocarcinoma after liver transplantation in situ were exam- ined by conventional ultrasound and CEUS. The largest lesion of multiple lesions in liver was observed by con- trast-enhanced ultrasound. The position, size, shape, border, internal echo, internal blood flow, the sur- rounding bloodvessel and the enhancement pattern of contrast-enhanced ultrasound of recurrent hepatocarcinoma were observed. The patterns of two-dimensional ultrasound, color Doppler and contrast-enhanced ultrasound of recurrent hepatocarcinoma were analyzed. Results The time of recurrence was 1.3-42 months after liver transplantation. There were 90 lesions in the transplanted livers and 6 lesions around the transplanted livers. Of all, 88 lesions were oval and 85 lesions were hypoechoic. The internal echoes of 76 lesions were not consist- ent. The borders of 68 lesions were clear. 55 lesions were detected with arterial flow signal. The enhancement pattern of 30 lesions in livers and 6 lesions around livers examined by CEUS was ＂quickly entering and quickly leaving＂ loith ＂wash-in＂ in early-phase and ＂wash-out＂ in late phase. CEUS showed hyper echoic in arterial phase and hypo echoic in late phase. Conclusions The recurrent hepatocarcinoma can occur around and in the transplanted liver. When the enhancement pattern of lesions examined by CEUS was ＂wash-in＂ in early- phase and ＂wash-out＂ in late phase, the recurrence of hepatocarcinoma could be diagnosed.