超声造影定量分析鉴别肝脏局灶性高回声小病灶良恶性的研究

Study of contrast-enhanced ultrasonography in diagnosis of hyperechoic small focal liver lesions

目的探讨应用超声造影鉴别诊断肝脏局灶性高回声小病灶(HSFLLs)良恶性的临床价值。方法回顾性分析我院经病理证实的75例HSFLLs患者(共107个病灶)的超声造影图像资料,绘制时间-强度曲线进行分析;并与增强CT检查结果进行比较。结果良性HSFLLs造影模式以"动脉相高增强,门脉相及延迟相高或等增强"或"三相等增强"为主,恶性HSFLLs造影模式以"动脉相高增强,门脉相及延迟相低增强或等增强"为主。良性HSFLLs造影剂灌注的达峰时间、始退时间分别为(42.5±17.3)s、(183.7±66.6)s,较恶性HSFLLs[(24.2±10.6)s、(77.9±46.0)s]长,差异均有统计学意义(均P<0.05)。以病理结果为金标准,超声造影对HSFLLs的诊断准确率为89.71%,增强CT的诊断准确率为88.79%;超声造影对肝硬化增生结节和小肝癌的诊断准确率为92.86%,增强CT的诊断准确率为90.48%。结论超声造影可有效动态地评估肝脏肿瘤的血流动力学,在对HSFLLs良恶性的鉴别诊断方面具有重要的临床价值。

Objective To investigate the application value of contrast-enhanced ultrasound（CEUS） in differential diagnosis of benign and malignant hyperechoic small focal liver lesions（HSFLLs）. Methods The CEUS data of 75 cases（107lesions）with HSFLLs proven by pathology were analyzed retrospectively,time- intensity curve（TIC）was drawn and analyzed,the results were compared with those of contrast-enhanced computed tomography（CECT）. Results The enhancement pattern of benign HSFLLs was mainly ＂hyperenhancement in arterial phase,hyperenhancement or isoenhancement in portal phase and late phase＂or ＂isoenhancement in three phases＂,and the enhancement pattern of malignant HSFLLs was mainly＂hyperenhancement in arterial phase,hypoenhancement or isoenhancement in portal phase and late phase＂. The time to peak,time to wash-out in benign and malignant HSFLLs were（42.5±17.3）s,（183.7±66.6）s and（24.2±10.6）s,（77.9±46.0）s,and the differences were both statistically significant（all P〈0.05）.Taking pathologic results as the gold standard,the diagnostic accuracy of CEUS and CECT were 89.71% and 88.79%.In the differential diagnosis of cirrhotic nodules and small hepatocellular carcinoma,the accurate rate of CEUS and CECT were 92.86% and 90.48%. Conclusion CEUS could evaluate the hemodynamics of liver tumors effectively and dynamically,and CEUS may be more helpful for the differential diagnosis of benign and malignant HSFLLs than CECT.