肝肿瘤动态三维超声造影与二维超声造影的比较研究

Comparison of enhancement features of hepatic tumors between dynamic three-dimensional and two-dimensional contrast-enhanced ultrasonography

目的 通过与二维超声造影（2D-CEUS）比较,探讨动态三维超声造影（3D-CEUS）在评价肝肿瘤血流灌注方面的价值.方法 对65例肝占位患者（共67个病灶）分别进行2D-CEUS和动态3D-CEUS检查,观察两种造影模式下不同肝肿瘤的动脉期增强方式、不同时相的清晰度或立体感、动脉期血管清晰度以及肿瘤血管的空间关系等方面的差异,并比较两种成像方法诊断肝肿瘤良恶性的价值.结果 动态3D-CEUS显示肝肿瘤的动脉期增强方式、动脉期和门脉期病灶的清晰度或立体感方面与2D-CEUS相似（P＞0.05）；3D-CEUS鉴别诊断肝肿瘤良恶性的敏感度、特异度、阳性预测值和阴性预测值分别为98.0％、81.3％、94.3％和92.9％,2DCEUS分别为96.1％、81.3％、94.2％和86.7％；两种方法之间鉴别诊断肝肿瘤良恶性差异无统计学意义（P ＞0.05）.动态3D-CEUS在显示动脉期血管清晰度及肿瘤血管空间关系上优于2D-CEUS（P＜0.05）.结论 动态3D-CEUS和2DCEUS一样可以准确地鉴别肝肿瘤的良恶性,且动态31D-CEUS可更直观和有效地显示肝肿瘤血管的空间立体关系,为肝肿瘤的诊断和治疗提供更丰富的空间信息.

Objective To investigate the enhancement features of hepatic tumors between dynamic three-dimensional contrast-enhanced ultrasonography （3D-CEUS） and two-dimensional contrast-enhanced ultrasonography （2D-CEUS）.Methods Totally,65 patients with 67 focal liver lesions were examined with 2D-CEUS and dynamic 3D-CEUS.Enhancement patterns,sharpness or three-dimensional effect in different phases,definition of blood vessel in arterial phase and spatial relationships of tumor and vascularity of different hepatic tumors on the two imaging modes were compared statistically,the value of two modes in differential diagnosis of hepatic tumors was also evaluated.Results Dynamic 3D-CEUS was similar to 2DCEUS with respect to enhancement patterns,sharpness or three-dimensional effect of tumor in arterial and portal phases（ P 〉0.05）.And there was no significant difference between the value of dynamic 3D-CEUS and 2D-CEUS in differential diagnosis of hepatic tumors：the sensitivity,specificity,positive predictive value and negative predictive value were 98.0%,81.3 %,94.3 % and 92.9% for 3D-CEUS,and were 96.1%,81.3%,94.2% and 86.7% for 2D-CEUS,respectively.However,3D-CEUS was superior to 2D-CEUS in the display of definition of blood vessel in arterial phase,and spatial relationships of hepatic tumor and vascularity（ P 〈0.05）.Conclusions Dynamic 3D-CEUS is a useful technique in the differential diagnosis of hepatic tumors as well as 2D-CEUS,and dynamic 3D-CEUS displays the spatial relationship of hepatic tumors and vascularity more visually and effectively,which provides additional information in the diagnosis and therapy of hepatic tumors.