超声造影用于肝硬化合并小肝癌的早期诊断价值

Value of contrast-enhanced ultrasonography in the early diagnosis of liver cirrhosis combined with small hepatocellular carcinoma

目的探讨超声造影用于肝硬化合并小肝癌的早期诊断的价值。方法选取西安医学院第二附属医院住院超声科2014年7月-2015年7月收治的50例肝硬化合并小肝癌患者,对于肝脏占位性病变进行超声造影检查,记录各个病灶造影增强模式,分析造影前后的占位性病变良恶性评分。结果超声造影对于肝硬化合并小肝癌的灵敏度为94.00%(47/50)。中-低分化癌组开始增强时间明显短于透明细胞癌组,开始消退时间明显短于高分化癌组,差异有统计学意义(P<0.05)。中-低分化癌组小肝癌动脉期多快速增强,即快进,当肿瘤内造影剂迅速廓清,实质期小肝癌肿瘤内超声回声强度低于正常肝实质,即为快出,本组占65.83%(79/120),穿刺活检经手术确诊78个为中-低分化癌病灶,其余1个为0.95 cm的透明细胞癌。高分化癌组动脉期快速增强,实质期缓慢退出,呈"快进慢出"模式,透明细胞癌组,超声造影呈"慢进慢出"模式。120个小肝癌病灶造影前典型图像较少,仅57.50%(69/120)有疑似或明确恶性诊断,超声造影后评分提高≥2分的病灶为35灶,占29.17%,造影后评价为5分的病灶为103灶,超声造影对小肝癌诊断准确性为85.83%(103/120)。结论超声造影用于肝硬化患者肝内合并多种类型小肝癌的早期诊断有重要价值,造影可提高超声的诊断率,可作为辅助诊断小肝癌的影像学方法,其灵敏度与准确度均较高,安全简便,值得临床上进一步推广应用。

Objective To investigate the value of contrast-enhanced ultrasonography in the early diagnosis of liver cirrhosis combined with small hepatocellular carcinoma. Methods Fifty cases of liver cirrhosis combined with small hepatocellular carcinoma in the Second Affiliated Hospital of Xi＇an Medical College from Jul. 2014 to Jul. 2015 were collected. Contrast-enhanced ultrasound examination was used for liver space-occupying lesions,contrast enhancement pattern of each lesion was recorded. Benign and malignant scores of space-occupying lesions before and after contrast-enhanced ultrasound were analyzed. Results The sensitivity of contrast-enhanced ultrasonography for liver cirrhosis combined with small hepatocellular carcinoma was 94. 00%（ 47 /50）. The enhancement time was significantly shorter in medium-low differentiation groupthan that in clear cell carcinoma group,regressiontime was significantly shorter in medium-low differentiation group than that in high differentiation group（ P〈 0. 05）. In medium-low differentiation group,contrast-enhanced ultrasound of small hepatocellular carcinoma in the arterial phase was fastenhancement（ fast forward）,when the tumor contrast agent in rapid clearance,the ultrasound echo intensity of small hepatocellular carcinoma insubstantial stage was lower than normal liver parenchyma（ P 〈0. 05）,which was fast out,accounted for 65. 83% in the group（ 79 /120）,78 cases were diagnosed by operation and biopsy in medium-low differentiation cancer lesions,and 1 case was 0. 95 cm clear cell carcinoma. Contrast-enhanced ultrasound of arterial phase was fast enhancement in high differentiation group,contrast-enhanced ultrasound of substantial stage slowly exited,it was ‘fast in and slow out＇mode,in clear cell carcinoma group,contrast-enhanced ultrasound showed ‘slow in and slow out＇mode. Typical images were less in 120 small hepatocellular carcinoma lesions before contrast-enhanced ultrasound,only 57. 5%（ 69 /120）were suspected or definite diagnosis of malignant. After contrast-enhanced ultrasound,there were 35 lesions（ 29. 17%）when CEUS score more than or equal to 2,and 103 lesions when CEUS score equal to 5. The accuracy of contrast-enhanced ultrasound in the diagnosis of small hepatocellular carcinoma was 85. 83%（ 103 /120）. Conclusion Contrastenhanced ultrasonography is important for the early diagnosis of liver cirrhosis patients with different types of small liver cancer. The contrast can improve the diagnostic rate of ultrasound. It can be used as a diagnostic method for diagnosis of small hepatocellular carcinoma. Its sensitivity and accuracy are relatively high,safe and simple,and it is worthy of further popularization and application.