常规超声及超声造影对结节性肝癌及肝局灶性结节性增生的鉴别诊断价值

Ultrasonographic features for differential diagnosis of nodular hepatocellular carcinoma and focal nodular hyperplasia

目的分析结节性肝癌及肝局灶性结节性增生(FNH)的超声特征及超声造影特征。方法回顾性分析40例结节性肝癌患者(结节性肝癌组)及40例FNH患者(FNH组)的临床资料,所有患者均接受常规超声及超声造影检查,观察两组患者的超声特征及不同时相的超声造影特征。结果结节性肝癌组患者门静脉癌栓(22.5%vs 0)、肝硬化(60.0%vs 15.0%)及淋巴结肿大(20.0%vs 2.5%)的发生率高于FNH组,中心瘢痕(15.0%vs62.5%)的发生率低于FNH组,病灶位于肝包膜下的比例(22.5%vs 52.5%)低于FNH组,差异均有统计学意义(P﹤0.05)。两组患者的超声动脉相均以高增强为主,动脉相增强模式比较,差异无统计学意义(P﹥0.05);对于门脉相及延迟相,结节性肝癌组患者均以低增强为主,FNH组患者均以等低增强为主,两组患者的门脉相及延迟相增强模式比较,差异均有统计学意义(Z=2.754、3.556,P﹤0.01)。结节性肝癌组患者的上升时间(RT)[(21.9±8.7)s vs(27.8±9.2)s]、达峰时间(TTP)[(29.6±9.3)s vs(36.1±11.8)s]及平均通过时间(m TT)[(102.1±37.7)s vs(136.2±42.1)s]均明显短于FNH组,灌注指数(PI)[(122.8±31.6)vs(85.9±22.2)]明显高于FNH组,差异均有统计学意义(P﹤0.01)。结论结节性肝癌和FNH具有较为典型的超声特征及超声造影特征,可对两者进行较准确的鉴别诊断。

Objective To analyze the ultrasonographic features for differential diagnosis of nodular hepatocellular carcinoma and focal nodular hyperplasia（FNH）. Method 40 patients with nodular hepatocellular carcinoma and 40 patients with FNH who were tested by conventional ultrasound and contrast-enhanced ultrasonography were enrolled. The ultrasonographic features of nodular hepatocellular carcinoma and FNH and the characteristics of contrast-enhanced ultrasound at different phases were observed. Result Compared to the FNH, the frequencies of vein tumor thrombus（22.5% vs0）, liver cirrhosis（60.0% vs 15.0%） and lymph nodes（20.0% vs 2.5%） in nodular hepatocellular carcinoma were significantly higher（P〈0.05）, while the frequencies of central scar（15.0% vs 62.5%） and sub-capsular located（22.5% vs52.5%） in nodular hepatocellular carcinoma were significantly lower（P〈0.05）. Both of nodular hepatocellular carcinoma and focal nodular hyperplasia were with high enhanced arterial phase, without significantly statistical difference（P〈0.05）; in the portal venous phase and delayed phase, nodular hepatocellular carcinoma mostly with low enhancement while FNH with equal and low enhancement, the differences were statistically significant（Z=2.754, 3.556, P〈0.01）. The RT [（21.9±8.7） s vs（27.8±9.2） s], TTP [（29.6＋9.3） s vs（36.1＋11.8） s] and m TT [（102.1＋37.7） s vs（136.2＋42.1） s] of nodular hepatocellular carcinoma were significantly lower than those of FNH, and the PI [（122.8＋31.6） vs（85.9＋22.2）] was significantly higher than that of FNH, the difference was statistically significant（P〈0.01）. Conclusion The ultrasonic morphological features and contrast-enhanced ultrasound features of nodular hepatocellular carcinoma and FNH were identifiable, which can be used for accurate identification.