肝脏局灶性炎性病变超声造影误诊分析

Analysis of misdiagnosis of focal liver inflammatory lesions by contrast sonography

目的探讨肝脏局灶性炎性病变超声造影(CEUS)误诊的原因,以提高CEUS的诊断水平。方法对2004年3月—2008年12月在中山大学附属第一医院、中山大学孙逸仙纪念医院、中山大学附属第三医院、中山大学附属肿瘤医院就诊的68例肝脏局灶性炎性病变患者的CEUS表现进行回顾性分析。结果 68例肝脏局灶性炎性病变中,24例肝脓肿、5例炎性假瘤、2例肉芽肿、37例其他局灶性炎症,全部经病理证实。动脉期以高增强为主,占61.8%(42/68);门静脉期及延迟期以低增强为主,占75.0%(51/68)、80.9%(55/68)。出现17例假阳性,包括肝细胞癌10例、肝转移瘤6例、恶性淋巴瘤1例。结论详细询问病史及CEUS诊断标准的不断完善可提高CEUS诊断肝脏局灶性炎性病变准确率。

Objective To investigate the reasons of misdiagnosis of focal liver inflammatory lesions by contrast-enhanced ultrasound, and to improve the diagnostic accuracy of liver inflammatory lesions. Methods The data of 68 patients with focal liver inflammatory lesions were collected from four hospitals affiliated to SUN YET-SEN University from March 2004 to December 2008 were retrospectively analyzed. Results There were 24 cases with liver abscess, 5 with inflammatory pseudotumor, 2 with granuloma, and 37 with other hepatic focal inflammatory lesions. All cases were indentified by pathological results. In arterial phase 61.8% of cases were hyper-enhancement, in portal vein phase 75.0% were hypo-enhancement and in late phase 80.9% were hypo-enhancement. There were 17 false-positive cases, including 10 cases of hepatocellular carcinoma, 6 cases of metastatic liver carcinoma and 1 case of malignant lymphoma. Conclusion The comprehensive analysis of the patient＇s medical history and improvement in diagnostic standard of contrast-enhanced ultrasound will lead to an increase in diagnostic accuracy of liver inflammatory lesions by contrast-enhanced ultrasound.