超声造影对增强计算机层析成像肝脏低密度病灶的诊断价值

Contrast-enhanced ultrasonography diagnostic value of the liver low-density focus on contrast- enhanced CT

目的探讨超声造影（CEUS）对增强计算机层析成像（CECT）肝脏低密度病灶的诊断价值。方法回顾性分析47例CECT提示肝脏低密度病灶的CEUS检查结果。结果47例病灶的病理结果为20例转移癌，9例炎性假瘤，6例血管瘤，4例原发性肝癌，2例囊肿，2例脓肿，2例结核，1例肝脏局灶性结节性增生（FNH），1例肝脏局部脂肪组织浸润。45例CEUS诊断结果与病理或临床诊断相符合。囊肿和炎性假瘤在整个CEUS时相无增强，但炎性假瘤内可有穿行的血管。肝脏局部脂肪组织浸润与肝脏同步增强。乏血供转移癌中80％（12／15）的表现为周边快速、轻度增强，内部轻微均匀增强；富血供转移癌中80％（4／5）表现为整体明显快速增强。脓肿和结核在CEUS中的强化程度与坏死程度有关，表现为快速不均匀增强。血管瘤周边向中心缓慢增强，其持续增强时间较转移癌长，差异有统计学意义。FNH的CEUS表现由中心向外快进快出的典型增强方式。原发性肝细胞肝癌CEUS表现为整体快进快出的增强方式。结论CEUS对CECT肝脏低密度病灶有一定的诊断价值，有助于此类病灶的鉴别诊断。

Objective To discuss the contrast-enhanced uhrasonography diagnostic value of the liver low-density focus on contrast-enhanced CT. Methods The contrast-enhanced ultrasonography results of 47 cases of the liver low-density focus on contrast-enhanced CT. were retrospectively analyzed. Results The pathological diagnosis in 47 focuses was metastatic carcinoma 20 cases, inflammatory pseudotumour 9 cases, hepatic hemangioma 6 cases, primary liver carcinoma 4 cases, cyst 2 cases, abscess 2 cases, tuberculosis 2 cases, FNH （focal liver nodular hyperplasia） 1 case, local adipose tissue infiltration of liver I case. 45 cases of contrast-enhanced ultrasonography diagnosis was consistent with pathological or clinical diagnosis. Cysts and inflammatory pseudotumour had not ultrasound contrast enhancement in the entire phase, but the crossed blood vessels was observed in inflammatory pseudotumour. The local adipose infiltration of liver had synchronous ultrasound contrast enhancement accompanied with liver tissue enhancement. 80 % （12/15） of liver metastases of lack of blood supply showed fast contrast enhancement around the tumour edge and homogeneous and light contrast enhancement in the tumour center. 80 % （4/5） of liver metastases of rich of blood supply showed heavy and rapid contrast enhancement in the whole tumour. The enhancement degree in abscess and tuberculosis in the ultrasound contrast enhancement was correlated with necrosis degree, which showed fast and uneven contrast enhancement, hepatic hemangioma showed gradually contrast enhancement from its edge to center, whose enhancement time lasted for longer time than that of metastatic tumour with a statistically difference. FNH showed a typical contrast enhancement pattern, fast enhancement and fast weakening from center to edge. Hepatic cell carcinoma showed fast enhancement and fast weakening in the whole tumour. Conclusion Contrast-enhanced ultrasonography have diagnostic value of CT liver focus of low-density, which is helpful for the differential diagnosis of such focus.