超声造影对提高肝多发占位穿刺活检的应用价值

The value of contrast-enhanced ultrasound in raising the accuracy of biopsy for multiple liver occupying lesions

目的：探讨超声造影（CEUS）对提高肝多发占位穿刺活检诊断率的临床应用价值。方法：对来我科就诊的128例常规超声检查诊断性质不明的肝多发占位患者随机分为两组,其中62例注射超声造影剂SonoVue行CEUS后行超声引导穿刺活检（CEUS组）,66例只采用常规超声引导穿刺活检（US组）。男86例,女42例;年龄36～74岁,平均53.2岁。穿刺病灶共178个,大小0.5~2.9 cm,平均1.4 cm。对比分析两组穿刺活检结果。取材量满足病理诊断为取材成功。结果：穿刺≤2针即获较满意标本量者CEUS组明显多于US组（P=0.000 2）。CEUS组76灶中确诊72灶（94.7%）;US组102灶中确诊为86灶（84.3%）（两组比较P=0.029）,差异有统计学意义。微小恶性肿瘤（≤2 cm）的确诊率CEUS组94.6%,明显高于US组的78.1%。本组无并发症发生。结论：CEUS可准确分辨肝内病灶的坏死区,敏感反映病灶血流灌注情况。CEUS引导穿刺活检可有效提高经皮穿刺活检的确诊率、降低常规超声引导穿刺活检的假阴性率,在肝多发占位穿刺活检中有重要的临床价值。

Objective： To evaluate the clinical utility of contrast-enhanced ultrasound（CEUS） in percutaneous liver biopsy of multiple liver lesions.Methods： One hundred and twenty-eight patients with multiple unidentified occupying lesions in liver were randomly divided into two groups： CEUS group in which 62 cases underwent liver biopsy directed by real time grey CEUS,and routine ultrasound（US） group in which 66 patients underwent biopsy guided by conventional ultrasonography.There were 86 males and 42 females,mean aged 53.2（36~74）.There was no significant difference in the size of lesions between the two groups.18 gauge needles were used in biopsy,and then biopsy specimens were sent to pathology department for histological and cytological examination.Acquirement of adequate quantity of specimen for pathological examination meant successful biopsy.Results： The proportion of no more than 2 puncture successful in the CEUS group was significantly higher than that in the US group（P=0.000 2）.The accurate diagnosis rate of the CEUS group was 94.7%,significantly higher than that of the US group（84.36%,P=0.029）.The accurate diagnosis rate of small malignant lesions in the CEUS group was 96.6%,significantly higher than that in the US group（82.1%）.No major complication occurred.Conclusion： Biopsy guided by CEUS is more accurate in diagnosis of malignant nodes and hyperplasia nodes in cirrhosis of liver by the reflection of the blood perfusion of lesions,and can determine the area of activity or the necrosis of malignant tumors accurately.It increased the success rate of biopsy and confirmed diagnosis rate of malignant lesions.