超声造影诊断隐匿性肝癌的临床应用

Clinical application of contrast-enhanced ultrasonography for malignant hepatic lesions undetected on conventional ultrasound

目的探讨超声造影对隐匿性肝癌的诊断价值。方法对2015年1月至2{）16年9月间临床症状及其他影像学检查怀疑肝癌的85例患者进行常规灰阶超声和超声造影检查。结果85例患者共92个病灶均经手术、临床症状或其他影像学检查证实。常规超声检出20个病灶（21．7％），超声造影检出89个病灶（96．7％），两种方法检出率比较差异有统计学意义（P〈0．01）。病灶最小为8mm×6mm，最大为20mm×18mm，所有病灶在灰阶声像图上显示为等回声、稍低回声或稍高回声，并且大部分边界不清或欠清。82个病灶（92．1％）表现为动脉期快速增强，同步增强7个（7．9％）。61个病灶（68．5％）门脉期减退呈低回声，28个病灶（31．5％）呈等回声，74个病灶（83．1％）延迟期减退呈低回声，15个病灶（16．9％）延迟期仍基本呈等回声改变。病灶开始增强时间为（15．3±6．1）S，达峰时间为（25．2±8．8）S，减退呈低回声时间为（95．7±57．8）S。89个病灶中，符合“快进快出”类型61个（68．5％），非“快进快出”类型28个（31．5％）。超声造影在隐匿性肝癌中非“陕进快出“的显示率明显高于一般性肝癌，二者比较差异有统计学意义（P〈0．01）。结论超声造影在隐匿性肝癌中具有较特征性的表现，相比常规超声有较高的检出率，值得在临床应用。

Objective To explore the value of contrast-enhanced ultrasound（CEUS） on the diagnosis of undetected liver cancer. Methods The study was focused on 85 consecutive patients from Jan 2015 to Sep 2016. The patients suspected liver cancer by clinical symptoms and other imaging studies were examined for regular gray-scale ultrasound and CEUS. Results Ninety-two lesions in 85 patients were confirmed by surgery, clinic manifestation and other imaging. All lesions including invisible or poorly invisible with grey- scale ultrasound were examined by CEUS with the guideline of MRI imaging. Twenty lesions were detected by grey-scale ultrasound, 89 lesions were detected by CEUS. The maximum diameter of those hepatic lesions was 20 mm x 18 mm, the minimum lesions was 8 mm × 6 mm. All the lesions were isoechoic, slightly hyperechoic or hypoechoic on grey-scale sonogram with mostly indistinctive margins. After SonoVue administration, 82 lesions （92.1%） displayed as hyper-enhanced in arterial phase and 7 lesions （ 7.9 % ） as iso-enhanced. Sixty-one lesions （68.5 % ） showed hypo-enhanced and 28 lesions （31.5 % ） showed iso-enhanced in portal-vein phase. Seventy-four lesions（83.1%） showed hypo-enhaneement and 15 lesions （16.9%） also showed iso-enhanced in late phase. The average enhancement time began at （15.3 ± 6.1）s, reached to peak at （25.2 ± 8.8）s and decreased from （95.7 ± 57.8）s. Among 89 lesions, 61 lesions （68.5%） were accordanced with fast in fast out and 28 lesions （31.5%） were no fast in fast out. The percentage of no fast in fast out on CEUS in undetected liver tumor was higher than in common liver tumor, the comparative difference was statistically significant （P 〈 0.01 ）. Conclusions Contrast-enhancedultrasound has a more characteristic performance in undetected liver cancer and the higher detection rate than grey-scale ultrasound.