超声造影在单发转移性肝癌与肝脏孤立性坏死结节鉴别诊断中的价值

Value of contrast-enhanced ultrasound in differential diagnosis of single metastatic liver cancer and solitary necrotic nodule of the liver

目的探讨超声造影对单发转移性肝癌(MHC)与肝脏孤立性坏死结节(SNNL)的鉴别诊断价值。方法对超声造影动脉相均呈"环状"增强的12例单发MHC和16例单发SNNL的超声图像进行回顾性分析,分别对两组患者年龄、病灶大小、二维灰阶超声及超声造影表现等进行对比。两组间计量资料比较采用两独立样本t检验,组内比较采用配对t检验。结果 MHC组的平均年龄显著高于SNNL组[(60.2±11.3)岁vs(41.0±9.1)岁],差异有统计学意义(t=4.970,P<0.001)。MHC组病灶平均直径为(2.86±1.22)cm,SNNL组为(2.97±0.96)cm,两组差异无统计学意义(t=-0.269,P=0.790)。MHC组病灶内部回声复杂、不均,边界以模糊为主;SNNL组病灶多以右叶多见,低回声为主,大部分边界清晰。两组病例彩色多普勒病灶内均未检出血流信号。超声造影动脉相,两组病灶周边均可见环状增强,MHC组平均厚度为(5.00±1.69)mm,SNNL组为(2.37±0.87)mm,两组比较差异有统计学意义(t=5.374,P<0.001);MHC组延迟相较动脉相病灶内无增强范围明显增大,差异有统计学意义(t=-4.508,P=0.001)。SNNL组延迟相与动脉相病灶内无增强范围差异无统计学意义(t=-0.449,P=0.660)。结论超声造影动脉相"增强环"的厚度及延迟相无增强范围增大与否,有助于鉴别单发性MHC与SNNL。

Objective To investigate the value of contrast- enhanced ultrasound（ CEUS） in the differential diagnosis of single metastatic hepatic carcinoma（ MHC） and solitary necrotic nodule of the liver（ SNNL）. Methods A retrospective analysis was performed for 12 patients with single MHC and 16 patients with SNNL who showed circular enhancement in arterial phase on CEUS. Age,size of lesion,and findings of two- dimensional gray- scale ultrasound and CEUS were compared between the two groups. The two- independent- samples t-test was used for comparison between groups,and the paired t- test was used for comparison within each group. Results The MHC group had a significantly higher mean age than the SNNL group（ 60. 2 ± 11. 3 years vs 41. 0 ± 9. 1 years,t = 4. 970,P〈0. 001）. The mean diameter of lesion was 2. 86 ± 1. 22 cm in the MHC group and 2. 97 ± 0. 96 cm in the SNNL group,and showed no significant difference between the two groups（ t =- 0. 269,P = 0. 790）. In the MHC group,the lesions had complex and uneven echoes and blurred boundaries,while in the SNNL group,most lesions were in the right lobe and were hypoechoic with clear boundaries. No blood flow signals were detected on CDFI in these two groups. Both groups had circular enhancement around the lesions in arterial phase on CEUS,and the mean thickness showed a significant difference between the MHC group and the SNNL group（ 5. 00 ± 1. 69 mm vs 2. 37 ± 0. 87 mm,t = 5. 374,P〈0. 001）. In the MHC group,the area in lesions without enhancement in delayed phase was significantly larger than that in arterial phase（ t =- 4. 508,P =0. 001）,while in the SNNL group,the area in lesions without enhancement showed no significant difference between delayed phase and arterial phase（ t =- 0. 449,P = 0. 660）. Conclusion The thickness of circular enhancement in arterial phase on CEUS and the presence or absence of the enlargement in the area without enhancement contributes to the differential diagnosis of single MHC and SNNL.