肝脏超声造影在肝癌术后肝内复发转移早期诊断的应用价值

Application Value of Contrast Enhanced Ultrasonography in Early Diagnosis for Postoperative Intrahepatic Recurrence and Metastasis in Hepatocellular Carcinoma

目的探讨肝脏超声造影在肝癌术后肝内复发转移早期诊断中应用价值。方法总结我院2008年3月至2012年5月68例原发性肝癌术后门诊和住院患者随访资料,超声造影(CEUS)检查68例,多层CT(MSCT)检查26例,磁共振(MRI)检查32例,数字减影血管造影(DSA)检查10例,肝穿刺病理检查6例。结果小于0.5 cm的复发或转移灶,肝脏CEUS检出率显著高于MSCT,同期检出率分别为85.7%、42.9%,差异具有统计学意义(P<0.05);MRI与CEUS同期检出率分别为72.2%、83.3%,差异具有统计学意义。直径在0.5 cm～1 cm复发或转移灶,MSCT与CEUS同期检出率分别为75%、93.4%,差异具有统计学意义(P<0.05)。大于1 cm的复发或转移灶,MSCT与CEUS同期检出率分别为80%、93.3%,差异具有统计学意义(P<0.05)。结论肝脏CEUS对于检出肝癌术后直径小于1 cm的复发或转移灶具有明显的优势,检出率高于MSCT和MRI,是肝癌术后随访早期诊断肝内复发转移的首选检查方法。

Objective To investigate the application value of contrast enhanced ultrasonography（CEUS） in early diagnosis for postoperative intrahepatic recurrence and metastasis in hepatocellular carcinoma.Methods 68 cases of postoperative patients with hepatocellular carcinoma were followed up at clinic or ward from Mar.2008 to May 2012.68 cases were conducted a contrast enhanced ultrasonography,26 cases of MSCT detection,32 cases of MRI detection,10 cases of DSA detection,6 cases of biopsy detection.Results The detection rate of CEUS for recurrent and metastatic lesions of less than 0.5 cm was higher than that of MSCT,homochronous detection rate was respectively 85.7%,42.9%（85.7% vs 42.9%,P〈0.05）;homochronous detection rate of MRI and CEUS was respectively 72.2%,83.3%（72.2% vs 83.3%,P〈0.05）.Homochronous detection rate of MSCT and CEUS for recurrent and metastatic lesions of 0.5 cm^1 cm was respectively 75%,93.4%（75% vs 93.4%,P〈0.05）.Homochronous detection rate of MSCT and CEUS for recurrent and metastatic lesions of more than 1 cm was respectively 80%,93.3%（80% vs 93.3%,P〈0.05）.Conclusion The detection rate of CEUS for recurrent and metastatic lesions of less than 1 cm is higher than that of MSCT and MRI in hepatocellular carcinoma after hepatectomy.CEUS is preferred approach to eraly detect the intrahepatic recurrent and metastatic lesions of hepatocellular carcinoma during postoperative follow-up.