高帧频超声造影在肝富血供占位性病变动脉期中的成像优势与临床价值

Advantages and value of high-frame-rate contrast-enhanced ultrasound in arterial phase in evaluating focal liver lesions with hypervascularity

目的探讨高帧频超声造影(H-CEUS)在肝富血供结节动脉期成像的优势及其潜在的临床价值。方法选取2018年5月至2019年12月在解放军总医院第一医学中心因肝局灶性病变而行超声造影(CEUS)检查患者88例。根据病理及增强磁共振结果分为恶性组和良性组。研究对象分别行超声、CEUS和H-CEUS检查并记录动态图像。2位医师分别对超声、CEUS和H-CEUS图像进行独立分析并记录结果,统计分析CEUS和H-CEUS图像特征。采用t检验比较良性组和恶性组患者年龄和结节最大径的差异,采用χ^2检验比较良性组和恶性组患者性别、结节数量和结节血流的差异、2种超声造影模式特征(开始增强时间、增强程度、均匀性、方向和血管形态)的差异以及2种造影模式下不同大小恶性结节血管形态的差异。结果良性组与恶性组间患者年龄(t=3.428,P=0.001)、结节最大径(t=3.039,P=0.003)及结节血流比较(χ^2=8.159,P=0.004)差异均有统计学意义。开始增强时间、增强程度与均匀性在CEUS和H-CEUS技术间比较,差异均无统计学意义(P均> 0.05)。造影增强方向及血管形态在2种造影技术间比较,差异均有统计学意义(χ^2=54.795、11.510,P均<0.05)。结节最大径≤3.0 cm的恶性组中2种造影技术在显示血管形态方面,差异有统计学意义(χ^2=12.983,P <0.001),结节最大径> 3.0 cm的恶性组中2种造影技术在显示血管形态方面,差异无统计学意义(P> 0.05)。结论通过提高超声图像帧频有助于准确地显示动脉期的增强特征和血管形态,尤其是对于最大直径≤3.0 cm的富血供结节H-CEUS可以弥补CEUS在这方面的局限性。

Objective To explore the advantages of high-frame-rate contrast-enhanced ultrasound(H-CUES)in the arterial phase in evaluating hypervascular focal liver lesions(FLL)by comparing with conventional contrast-enhanced ultrasound(CUES)and to clarify the potential clinical value of this technique.Methods A total of 88 patients with focal liver lesion(FLL)were enrolled in this study at the First Medical Centre of Chinese PLA Genral Hospital from May 2018 to December 2019.The patients were divided into either a malignant lesion group or a benign lesion group.All malignant lesions were proved by pathological findings and all benign lesions were proved by contrast-enhance magnetic resonance imaging.Gray-scale ultrasound(US),CUES,and H-CEUS were performed in each patient.US,CUES,and H-CEUS images were interpreted independently by two doctors and images features were statistically analyzed between CUES and H-CEUS.The t test was used to compare the difference of age and nodule maximum diameter between benign and malignant groups,andχ^2 test was used to compare the differences of sex,nodule number and nodule blood flow between benign and malignant groups,the characteristics of two contrast-enhanced models(start enhancement time,enhancement degree,uniformity,direction and vascular morphology),and the differences of vascular morphology of malignant nodules of different sizes under contrast-enhanced models.Results There were significant differences in patient age(t=3.428,P=0.001),maximum diameter of FLL(t=3.039,P=0.003),and blood flow within FLL by CDFI(χ^2=8.159,P=0.004)between the two groups.Start time,intensity,and homogeneity of enhancement did not differ significantly between CEUS and H-CEUS(P>0.05).Fill-in direction(χ^2=54.795,P<0.05)and vascular morphology(χ^2=11.510,P<0.05)differed significantly between CEUS and H-CEUS.In malignant FLL with maximum diameter<3.0 cm,there was a significant difference in vascular morphology between CUES and H-CEUS(χ^2=12.983,P=0.001),but in malignant FLL with maximum diameter>3.0 cm,there was no significant difference(P>0.05).Conclusion By increasing the frame rate of CEUS,H-CEUS could dynamically and accurately display fill-in patterns and vascular morphology in the arterial phase,especially in FLL with maximum diameter<3.0 cm.H-CEUS can compensate for the limitations of CEUS in this respect.