大鼠肝泡球蚴病模型早期超声造影表现与病理对照分析

Contrastive analysis of contrast-enhanced ultrasonography in assessing early infection stage in rat with hepatic alveolar echinococcosis

目的探讨超声造影揭示早期大鼠肝泡球蚴病灶血流灌注的价值。方法开腹直视下肝内感染泡球蚴9 w的33只大鼠,进行常规超声、超声造影检查,详细记录不同检查方法的影像特征,并与病理对照。结果常规超声和超声造影筛查早期大鼠肝泡球蚴病灶的敏感性分别为91.67%和81.82%。超声表现主要表现为高回声型(29/33,87.88%)和混合性回声(4/33,12.12%),经病理证实所有病灶均表现为单个或多个囊泡样结构。33个病灶彩色多普勒超声均未显示血流信号,14个病灶(14/30,46.67%)超声造影显示为动脉期环状强化,14个病灶(14/30,46.67%)显示动脉期及门脉期环状强化伴内部分隔强化,2个病灶(2/30,6.66%)未见明显强化。超声造影显示的增强区域,经病理证实为泡球蚴病灶周边富含微血管的炎性反应带。结论常规超声在筛查大鼠肝泡球蚴病中,较超声造影具有较高的灵敏度,然而,超声造影可以显示病灶内部的囊泡和病灶内部及周边的血流灌注情况。

Objective To assess the effectiveness of Contrast-enhanced ultrasonography （CEUS） in screening for hepatic alveolar echinococcosis （HAE） at early infection stage in rat model. Methods 33 rats were intraheptacilly infected with E. mutilocularis, Utrasonography （US） and CEUS features of HAE le- sions were recorded after 9 weeks post infection, compared with pathology, and the accuracy and effective- ness of US and CEUS were assessed according to the principle of diagnostic test. Results US and CEUS had a high sensitivity of 91.67% and 81.82% in screening the early HAE in rats. The typical ultrasono- graphic features of HAE lesions were hyper-echoic（29/33,87.88%）, and 4 lesions presented mixed pattern （4/33,12.12%）. Single or multiple milky white or beige cyst-like nodules containing fluid were observed in the liver by using pathological examination. Hematoxylin-eosin （HE） staining showed that the small cyst was surrounded by the characteristically proliferated small blood vessels and infiltrated inflammatory ceils. CDFI failed to detect blood flow signals in 33 lesions. CEUS results for 14 lesions （14/30,46.7%） showed ring enhancement in the peripheral area during the arterial phase and no filling effect in either the portal or the delayed phase and ring enhancement combined with central septa enhancement during the arterial phase and portal venous phase （14/30,46.7）, and no enhancement in 2 lesions （2/30,6.6%）. The enhanced area, confirmed by pathologic examination, was an inflammatory reaction belt surrounding the lesion. Conclusion This study suggests that US, with higher sensitivity, can be recognized as a screening method for early HAE le- sions in the animal model, while CEUS can be used for displaying the peripheral and internal blood perfusion.