超声造影对Budd-Chiari综合征合并肝脏局灶性结节的鉴别诊断价值

Differential diagnosis of focal liver lesions in Budd-Chiari syndrome by contrast-enhanced ultrasonography

目的探讨Budd-Chiari综合征(BCS)合并肝脏局灶性结节的超声造影鉴别诊断要点。方法回顾性分析36例BCS合并肝局灶性结节患者的常规超声及超声造影图像,并结合临床病理检查和增强CT及MRI成像等其他影像学检查资料分析。结果 36例BCS患者中11例合并肝癌结节,25例合并增生结节。其中BCS合并肝癌结节超声造影模式为典型的"快进快出",BCS合并增生结节的超声造影表现是多样化的,可分为3型。Ⅰ型增生结节超声造影3个时相与周围肝实质相比均呈等增强;Ⅱ型和Ⅲ型虽然造影特点不同,Ⅱ型动脉相呈离心性增强,Ⅲ型动脉相呈环状向心性增强,但延迟相均较周围肝实质呈等增强或部分高增强。结论 BCS合并肝脏局灶性结节超声造影表现呈多样化,超声造影对鉴别结节良恶性有重要价值。

Objective To explore differential diagnosis features of focal liver lesions in Budd-Chiari syndrome （BCS） by contrast-enhanced ultrasonography （CEUS）. Methods The conventional sonogram and CEUS features of 36 BCS patients with focal liver lesions were retrospectively analyzed combined with histopathological confirmation and other image examinations （e.g. helical CT and MR image）. Results Twenty-five patients had regenerative nodules, and eleven patients had hepatocellular carcinoma （HCC）.All of HCC lesions were shown with typical ＂fast-in and fast-out＂ pattern by CEUS. Regenerative nodules can be classified into three types according to the CEUS features. TypeⅠwas shown with iso-enhanced in arterial phase, portal phase and late phase, respectively. TypeⅡwere different from type Ⅲ regarding features of CEUS, in arterial phase typeⅡwas shown with centrifugal filling and type Ⅲ with centripetal rim enhancement, but both of them with iso-enhancing or partial hyper-enhancing in the delayed-phase. Conclusion Focal liver lesions in patients with BCS have different features by CEUS, which are useful for differential diagnosis.