影像融合超声造影对常规超声难以显示的≤2cm肝局灶性病变的诊断价值

The diagnostic value of focal liver lesion （≤42 cm） undetectable on conventional ultrasound by image fusion with contrast-enhanced ultrasound

目的探讨影像融合超声造影对常规超声难以显示的≤2cm的肝局灶性病变的诊断价值。方法收集肝局灶性病变（≤2cm）患者50例共65个病灶，CT／MRI图像中病灶均显示清楚而常规超声难以显示。对这些病灶行超声-CT／MRI容积导航实时定位，并在融合成像下行超声造影。记录并分析影像融合下超声造影病灶检出情况及病灶造影灌注模式。结果50例患者均匹配成功，影像融合超声造影共检出56个病灶（86．2％，56／65），其中27个病灶（41．5％，27／65）常规超声回声与周围组织差异显著，54个病灶（83．1％，54／65）超声造影回声与周围组织差异显著。46个病灶根据手术病理或临床综合获得明确诊断，影像融合超声造影良恶性诊断准确率为91．3％（42／46）。根据MRI匹配序列不同分组为T2序列组（32个）与增强序列组（23个），两组影像融合超声造影病灶检出率分别为87．5％（28／32）、91．3％（21／23）。组间比较差异无统计学意义（P=0．686）。结论超声-CT／MRI影像融合联合超声造影对常规超声难以显示的肝内小病灶具有较高的定位及定性诊断价值。

Objective To evaluate and explore the diagnostic value of focal liver lesion （FLL） （≤42 cm） undetectable on conventional ultrasound by image fusion with contrast-enhanced ultrasound（CEUS）. Methods A total of 50 patients with 65 lesions（≤2 cm） were enrolled. All lesions were undetectable on conventional ultrasound but showed clearly in CT/MRI images. Ultrasound-CT/MRI image fusion with CEUS was performed, and the nodule detection rate and enhancement perfusion mode were analyzed. Results All the 50 patients were matched successfully, 56 lesions （86.2% ） were detected by image fusion combined with CEUS, among which 27 lesions （41.5 % ） were significantly different from surrounding parenchyma on conventional ultrasound, 54 lesions （83.1%） showed different enhancement from the surrounding parenchyma on CEUS. There were 46 lesions that were eventually diagnosed by surgical pathology or clinical comprehensive diagnosis. The diagnostic accuracy of image fusion with CEUS was 91.3 % （42/46）. According to different groups of MRI matching sequences, the detection rates of T2 sequence group and enhanced sequence group were 87.5% （28/32） and 91.3% （21/23）, respectively, there was no statistically significant difference between the two groups （ P = 0.686）. Conclusions CT/MRI image fusion combined with CEUS has high detection rate and diagnosis accuracy for small FLL undetectable on conventional ultrasound.