肝炎性假瘤超声造影诊断研究

The value of contrast-enhanced ultrasound in diagnosis of hepatic inflammatory pseudotumor

目的观察肝炎性假瘤（hepaticinflammatorypseudotumor，HIPT）超声造影表现，提高对HIPT超声造影表现的认识，评价超声造影在诊断HIPT中的价值。方法回顾性分析47个经病理证实为HIPT病灶的超声造影表现，比较超声造影前后病灶的诊断符合率。结果47个病灶中5个病灶（10．64％，5／47）表现为动脉期、门脉期和延迟期始终不增强。其余42个病灶中29个病灶（61．70％，29／47）在动脉期、门脉期和延迟期表现为高一低一低回声。在动脉期，17．02％（8／47）的病灶呈周边细线状环状高回声，27．66％（13／47）呈整体均匀高回声，23．40％（11／47）呈整体不均匀高回声，17．02％（8／47）呈整体等回声，4．26％（2／47）呈整体低回声。以病灶动脉期呈无增强（5／47）或周边细线状环状高回声（8／47）或动脉期即出现快速离心性减退（4／47）或中央出现囊肿样无回声区（8／47），考虑为HIPT，则超声造影诊断HIPT的符合率53．19％（25／47），明显高于常规超声的诊断符合率12．77％（6／47），差异有统计学意义（P〈0．05）。结论超声造影可动态观察HIPT的血流灌注情况，提高HIPT的诊断符合率。

Objective To increase the comprehension and evaluate the value of contrast-enhanced ultrasonography （CEUS） in diagnosis of hepatic inflammatory pseudotumor （HIPT）by observing its appearance of CEUS. Methods Forty-seven cases of HIPT with 47 lesions were examined by CEUS and the imagings were retrospectively analyzed. All of the cases were pathologically identified. The diagnostic accuracies in HIPT before and after CEUS were compared. Results Five of forty-seven （10.64%, 5/47） cases of HIPT presented non-enhancement in arterial, portal and delayed phases, while 29 of the other 42 cases （61.70%,29/47） presented with hyper-hypo-hypo echogenicity in arterial, portal and delayed phases respectively. In arterial phase, 17.02% （8/47） cases demonstrated thin-rim-like enhancement, while 27.6605 （13/47） cases presented with entirely homogeneous hyper-enhancement and 23.40 %（ 11/47） cases with entirely heterogeneous hyper-enhancement, entirely iso-enhancement in 17.02% （8/47） cases and entirely hypo-enhancement in 4.26% （2/47） cases. The accurate rate of diagnosis for HIPT by CEUS was 53.19%（25/47） if the diagnostic criterion was set as that the lesions presented non-enhancement（5-47） or thin-rim-like enhancement（8/47） in arterial phase or quick centrifugal wash-out in arterial phase（4/47） or cyst-like echoless area in the lesion （8/47） should be considered as HIPT. It is higher than that by conventional ultrasound, which is 12.77 % （6/47）, with statistical significance （ P〈 0.05 ）. Conclusions CEUS is an imaging modality used to dynamically observe the blood perfusion and is beneficial to increase the accurate rate of diagnosis of HIPT.