超声造影对肝脏孤立性坏死结节的诊断价值

Diagnostic value of contrast-enhanced ultrasonography for solitary necrotic nodule of the liver

目的总结肝脏孤立性坏死结节(SNNL)超声造影所见,进一步探讨超声造影在其诊断及鉴别诊断中的作用。方法回顾性分析2005年4月-2014年5月于中国医科大学附属盛京医院超声造影诊断为SNNL的23例患者25个病灶的超声及造影表现。结果手术切除经病理证实为SNNL者有5例;18例经超声随访或其他影像学(增强CT或增强磁共振成像)证实为坏死结节。25个孤立性坏死结节病灶中,12个病灶内三相均未见造影剂填充呈无增强;13个病灶动脉相病灶周边呈薄环状高增强,门脉相及延迟相与肝实质呈等增强,病灶内部三相均未见造影剂填充。结论病灶整体三相无增强或病灶周边薄环状增强,内部三相无增强是SNNL的特征性超声造影表现,这一特点有益于其他肝脏占位性病变的鉴别。

Objective To summarize the imaging characteristics of solitary necrotic nodule of the liver（ SNNL） on contrast- enhanced ultrasonography（ CEUS） and to investigate the role CEUS plays in the diagnosis and differential diagnosis of SNNL. Methods Twenty- five lesions of 23 cases diagnosed with SNNL by CEUS were retrospectively analyzed for findings of ultrasonography and contrast enhancement.Results Five patients were confirmed with SNNL by pathological examination of surgically resected liver tissue; necrotic nodule was confirmed in 18 patients by ultrasonographic follow- up or other imaging methods（ contrast- enhanced computed tomography or contrast- enhanced magnetic resonance imaging）. In 12 of the 25 SNNL lesions,no contrast agent enhancement was observed in all phases; 13 lesions showed thin- ring enhancement around the lesions on the arterial phase images and iso- enhancement with the liver on the portal and delayed phase images without enhancement inside the lesions in all phases. Conclusion The typical imaging of SNNL on CEUS is no enhancement of the whole lesion in all phases or thin- ring enhancement around the lesion with no enhancement inside the lesion in all phases,which is helpful for the differentiation from other space- occupying lesions of the liver.