超声造影评估原发性与转移性小肝癌的血流动力学比较研究

Comparison of hemodynamics of primary and metastatic small hepatic carcinomas on contrast-enhanced ultrasonography

目的探讨原发性和转移性小肝癌超声造影的血流动力学差异。方法回顾性分析经病理及临床证实的210个原发性小肝癌和93个转移性小肝癌的超声造影表现,比较两组小肝癌在动脉期、门脉期和延迟期增强表现的异同。结果(1)303个小肝癌病灶,超声造影表现为动脉期快速增强、门脉期或延迟期消退,转移性小肝癌增强达峰时间和开始消退呈低回声时间明显早于原发性小肝癌(P<0.05)。(2)超声造影动脉期显示,95.7%(201/210)的原发性和2.3%(2/93)的转移性小肝癌呈高回声(P<0.05),门脉期及延迟期显示原发性和转移性小肝癌的血流动力学变化差异无统计学意义(P>0.05)。(3)在超声造影动脉期增强形态上,原发性小肝癌和转移性小肝癌分别有93.4%(196/210)和35.5%(33/93)的病灶呈整体均匀性增强(P<0.05);转移性小肝癌中,54.8%(51/93)的病灶周边呈环状或不规则状增强,明显高于原发性小肝癌的5.2%(11/210),差异有统计学意义(P<0.05)。结论转移性和原发性小肝癌在超声造影动脉期均呈快速增强,但在增强方式和开始消退呈低回声的时间上均存在一定差异。超声造影为原发性与转移性小肝癌的诊断与鉴别诊断提供了重要的影像学依据。

Objective To analyze the hemodynamics of primary and metastatic small hepatic carcinomas on contrast-enhanced ultrasonography. Methods Totally,210 primary and 93 metastatic small hepatic carcinoma lesions were examined by contrastenhanced ultrasound. The enhancement patterns on the arterial,portal and delayed phases between the two groups were summarized.Results（ 1） In 303 small primary hepatic carcinoma lesions,contrast-enhanced ultrasound showed rapid enhancement in the arterial phase,and clearance in the portal and delay phase. While dynamic contrast-enhanced ultrasonography displayed that the enhancement peak time and the time from clearance of enhancement echo to hypoecho of metastatic small hepatic carcinoma were obviously earlier than those of primary hepatic carcinoma（ P 0. 05）.（ 2） Contrast-enhanced ultrasound showed that 95. 7%（ 201 /210） of primary small hepatic carcinoma and 2. 3%（ 2 /93） of metastatic small hepatic carcinoma in the arterial phase were hyperechoic（ P 0. 05）,while hemodynamic changes of primary and metastatic small hepatic carcinomas had no statistical difference（ P 0. 05） in the portal and delayed phase.（ 3） On the arterial contrast enhancement pattern,93. 4%（ 196 /210） lesions of primary small hepatic carcinoma showed overall uniformity,while that in metastatic small hepatic carcinoma was 35. 5%（ 33 /93） with statistic significance（ P 0. 05）. And 54. 8%（ 51 /93） lesions of metastatic small hepatic carcinoma showed peripheral annular enhancement or irregular enhancement,much higher than 5. 2%（ 11 /210） in primary small hepatic carcinoma（ P 0. 05）. Conclusion Metastatic and primary small hepatic carcinomas present hyper-enhancement in the arterial phase of contrast-enhanced ultrasound. However,they are different at enhancment pattern and the time from clearance of enhancement echo to hypoecho. Contrast-enhanced ultrasound has an important clinical value for diagnosis and differential diagnosis of primary and metastatic small hepatic carcinomas.