四维及二维超声造影在肝肿瘤诊断中的对照研究

A comparison between four- and two-dimensional contrast-enhanced ultrasonographic imaging techniques as applied to liver tumor diagnosis

目的通过对比四维和二维超声造影对肝肿瘤显示及诊断的异同,探讨四维超声造影对肝肿瘤诊断的临床价值。方法对17例(19个病灶)肝肿瘤患者先后进行二维和四维超声造影,经肘静脉注射超声造影剂SonoVue后观察肿瘤形态、灌注方式及滋养血管的特征。对比总结肝肿瘤四维超声造影的表现,分析其对肝肿瘤诊断的价值。结果二维和四维超声造影均显示原发性肝癌强化方式呈"快进快出";肝转移瘤稍晚动脉期周边增强,而在门脉期和延迟期无强化;肝血管瘤呈"慢进慢出";原发性肝癌射频治疗术后病灶三期均无明显强化,四维超声造影图像上呈"空洞样"。四维超声造影时可更清晰地动态显示肝肿瘤立体形态,且动态显示的肝肿瘤滋养血管条数及其分支明显增多、分布更加密集。结论四维超声造影图像立体感、层次感更强,能动态、连续显示肝肿瘤灌注及其滋养血管特征,可作为一种辅助肝肿瘤诊断的新方法。

Objective To demonstrate the advantages of four-dimensional contrast-enhanced ultrasonography（4DCEUS） over two-dimensional contrast-enhanced ultrasonography（2D-CEUS） in the diagnosis of liver tumors. Methods 4D- and 2D-CEUS images were obtained in 19 liver tissues from 17 patients.After a venous bolus injection of SonoVue,images of every phase were recorded,and a comparison between the two imaging techniques was made. Results In both 4D-CEUS and 2D-CEUS,primary carcinoma of the liver showed fast enhancement in the arterial phase.During portal venous and late phases,the contrast agent was rapidly washed out.In the arterial phase,the hemangiomas exhibited a centripetal enhancement.During portal venous and late phases,the contrast agent was slowly washed out.Liver metastases showed enhancement only in the periphery（＇ rim enhancement＇） during the later arterial phase,and appeared as dark defects in the portal and late phases.After interventional therapy for the primary carcinoma, hypoechoic enhancement was observed during the three phases.In 4D-CEUS,the details of tumors were revealed with great clarity in a dynamic fashion.There were more vasa vasorums observed around the tumor,and more vessels detected inside the lesion.Conclusions Compared with conventional 2D-CEUS,4D-CEUS provides improved visualization of liver tumors in general and more perceptible information on the spatial relationship between the vasa vasorums and the target tumor in particular.This technique can be used as a new,complementary method in the diagnosis of liver tumors.