SonoVue超声造影在肝硬化局灶性小病变中的诊断价值

Diagnostic Value of Contrast Agent Sonovue for Focal Liver Lesions in Patients with Posthepatitic Cirrhosis

目的探讨新型造影剂SonoVue对肝硬化背景下肝局灶性小病变的诊断价值。方法采用造影剂SonoVue和对比脉冲序列(CPS)技术,对43例肝硬化背景下可疑肝局灶性病变48个病灶病变行超声造影检查。38例经手术或穿刺病理,5例经CT、MRI增强检查和临床综合资料证实病灶性质。结果恶性病灶组和良性病灶组达峰时间、始消时间和持续时间比较,差异有统计学意义(P<0.05)。21例肝细胞癌21个病灶和3例转移性肝癌4个病灶表现为在动脉相均匀增强;2例肝胆管细胞癌2个病灶和2例转移性肝癌3个病灶,表现为动脉相不均匀增强且以周边增强为主;1例肝细胞癌1个病灶在所有时相均呈等增强。肝血管瘤7例9个病灶,表现为动脉相以周边结节状增强,门脉期及延迟期病灶增强范围呈向心性扩散。3例局灶性结节增生3个病灶呈轮辐状从病灶中央向周边增强。4例肝硬化结节5个病灶在3个时相均呈等增强。本组超声造影诊断正确率为97.68%,假阴性率为3.45%。结论超声造影对肝硬化背景下局灶性小病变的良恶性鉴别有重要的诊断价值。

Objective To explore the role of new contrast agent Sonovue in the diagnosis of focal liver lesions in patients with posthepatitic cirrhosis. Methods Forty-four patients with focal liver lesions underwent contrastenhanced uhrasonography.Of them,38 cases had pathological evidence through surgery or needle biopsy. Results There were significant differences between benign and malignant lesions in the time to peak,time to wash-out and time of enhancement duration （P〈0.05）.21 hepatocellular carcinomas（21 lesions）and 3 metastatic hepatic carcinoma （4 lesions）showed enhancement in arterial phase;2 intrahepatic cholangiocarcinomas（2 lesions）and 2 metastases （3 lesions）presented with rim enhancement; 1 intrahepatic cholangiocarcinomas（1 lesions）showed isoeehoie in all phases. 7 hamangiornas （9 lesions）showed peripheral nodular enhancement in arterial phase and centripetal filling in portal phase and delayed phase. 3 focal nodular hyperplasias（3 lesions）presented with spoke wheel enhancement in arterial phase. 3 cirrhotic nodule （4 lesions）were isoechoie in all phases. The diagnostic accuracy and false negative rate of uhrasonic contrast were 97.68% and 3.45% respectively. Conclusion Contrast-enhanced uhrasonography is valuable in differentiate diagnosis of benign from malignant focal liver lesions in patients with posthepatitic cirrhosis.