超声造影灌注时相分析在监控肝硬化结节演变和恶变中的临床价值

Value of contrast-enhanced ultrasound in monitoring liver cirrhotic and dysplastic nodules and early diagnosis of hepatocellular carcinomas

背景与目的:原发性肝癌多在慢性肝炎、肝硬化的基础上发生,一般认为,肝硬化结节(cirrhotic nodule,CN)、异型增生结节(dysplastic nodule,DN)等一系列过程,最终演变为肝细胞癌(hepatocellular carcinoma,HCC)。应用实时超声造影对肝硬化患者进行定期跟踪监测,探讨超声造影在CN演变和HCC早期诊断中的价值。方法:在2007年3月—2017年12月于复旦大学附属中山医院就诊的9 550例慢性乙肝患者中,选取定期超声随访的392例患者的551枚结节作为研究对象,以病理学检查及影像学诊断为标准,分析不同性质结节在超声造影灌注时相的增强表现特点。结果:肝内551枚结节中确诊微小HCC(≤2 cm)55枚、DN 19枚和CN 477枚。常规超声显示,肝内CN、DN和HCC均以低回声多见,分别占61.6%(294/477)、78.9%(15/19)和67.3%(37/55)。超声造影显示,CN的造影特征以等-等-等的增强方式为主,占89.5%(427/477);DN的造影特征以低-等-等的增强方式最多见,占52.6%(10/19);微小HCC的造影特征则以高-等-等和高-等-低的增强方式最多见,占85.5%(47/55)。超声造影诊断CN、DN和HCC的准确率分别为93.3%、78.9%和85.5%。结论:超声造影灌注时相分析可客观地反映肝内CN、DN及微小HCC的不同灌注模式,应用超声造影定期监测肝硬化的结节,可及时预警和早期诊断微小HCC,改善患者预后。

Background and purpose:Primary liver cancer occurs mostly on the basis of chronic hepatitis and liver cirrhosis.It generally develops through a series of processes,such as cirrhotic nodule(CN)and dysplastic nodules(DN),and finally evolves into hepatocellular carcinoma(HCC).In this study,contrast-enhanced ultrasound(CEUS)was used to monitor patients with cirrhotic nodules regularly,and the value of CEUS was evaluated in the early diagnosis of HCC.Methods:From January 2007 to December 2017,9 550 patients with chronic liver cirrhosis who treated in Zhongshan Hospital,Fudan University were enrolled,among them 392 patients with 551 intrahepatic nodules were examined every 3 to 6 months.The perfusion features on CEUS were analyzed and compared with the results of pathological and imaging diagnosis.Results:Among 551 intrahepatic nodules,there were 55 small HCCs(less than 2 cm),19 DNs and 477 CNs confirmed clinically.Conventional ultrasound showed hypoechogenic nodules in 61.6%(294/477)of CNs,78.9%(15/19)of DNs and 67.3%(37/55)of HCCs.On CEUS,the most common perfusion features of nodules in three vascular phases were iso-iso-iso enhancement pattern in CN(89.5%,427/477),hypo-iso-iso pattern in DN(52.6%,10/19)and hyper-iso-iso enhancement and hyper-iso-hypo enhancement patterns in small HCC(85.5%,47/55)compared with liver parenchyma.The diagnostic accuracy of CEUS was 93.3%,78.9%and 85.5%for CN,DN and HCC,respectively.Conclusion:CEUS reflects the perfusion features of CN,DN and HCC objectively.Regular monitoring of cirrhotic nodules with CEUS makes prompt warning and early diagnosis of small HCC possible in clinical setting.