超声造影诊断肝包膜下小肝癌的临床价值

Clinical value of contrast-enhanced ultrasound in the diagnosis of subcapsular small liver cancer

目的:探讨超声造影对肝包膜下小肝癌的诊断价值。方法:选取2017年1月至2019年7月间临床表现或其他影像学诊断怀疑为肝包膜下肝癌的51例患者,分析其常规超声和超声造影的表现,并总结其特征。结果:51例患者,共53个病灶,经手术、介入、临床表现或影像学检查证实。所有病灶均位于肝脏包膜下,45个病灶紧贴肝包膜,8个病灶位于肝包膜下10 mm以内。肝包膜下病灶以等回声和稍高或稍低回声为主,占90.6%(48/53),肿块边界不清和欠清者占94.3%(50/53)。超声造影显示53个病灶中48个表现为动脉期快速增强,同步增强5个。门脉期38个病灶减退呈低回声,占71.7%(38/53);15个病灶呈等回声,占28.3%(15/53);延迟期50个病灶减退呈低回声,3个病灶仍呈等回声改变。53个病灶中,超声造影检查符合"快进快出"类型38个,占71.7%(38/53);"快进慢出"类型12个,占22.6%(12/53);"快进不出"类型3个,占5.7%。常规超声检出15个病灶,检出率为28.3%(15/53),超声造影检出53个病灶,检出率为100%(53/53),两种方法比较差异有统计学意义(P<0.01)。结论:超声造影对肝包膜下小肝癌具有很高的检出率,值得在临床应用。

Objective:To evaluate the value of contrast-enhanced ultrasound(CEUS)in the diagnosis of subcapsular small liver cancer.Methods:Fifty-one patients diagnosed with subcapsular liver cancer by ultrasound or other imaging between January 2017 and July 2019 were enrolled.The manifestations of conventional ultrasound and contrast-enhanced ultrasonography were analyzed,and the characteristics,summarized.Results:There were a total of 53 lesions,all of which were confirmed on the basis of surgical findings,clinical manifestations,or imaging findings.All lesions were located under the liver capsule.Forty-five lesions were located close to the liver capsule,whereas 8 lesions were located within 10 mm from the liver capsule.Of the subcapsular lesions,90.6%(48/53)were isoechoic and slightly higher or lower echoic,and 94.3%(50/53)had unclear boundaries.CEUS revealed rapid arterial enhancement in 48 of 53 lesions and synchronous enhancement in 5 lesions.In the portal phase,38 lesions(71.7%)presented hypoechoic changes,and 15 lesions presented isoechoic changes.In the delayed phase,50 lesions(94.3%)presented hypoechoic changes,and 3 lesions presented isoechoic changes.Among the 53 lesions,the"fast in and fast out"type was found in 38 cases(71.7%)and the"fast in and slow out"type,in 12 cases(22.6%).There were also 3 cases(5.7%)of"fast in and no out"type.Conventional ultrasound revealed 15 lesions,with a detection rate of 28.3%(15/53),and contrast-enhanced ultrasound revealed 53 lesions,with a detection rate of 100%(53/53).The difference between the two methods was statistically significant(P<0.01).Conclusions:Contrast-enhanced ultrasound has a high detection rate for subcapsular small liver cancer and has a significant clinical value.