超声造影、增强CT对肝硬化背景下肝内微小结节的诊断价值

Diagnostic Value of Contrast-enhanced Ultrasonography and Enhanced CT in the Diagnosis of Intrahepatic Micro Nodules in the Context of Cirrhosis

目的探讨超声造影、增强CT对肝硬化背景下肝内微小结节的诊断价值。方法选取2017年6月至2019年1月于我院就诊治疗的60例肝硬化患者作为研究对象,所有患者均行超声造影和增强CT检查,比较不同检查方式对肝硬化患者肝内微小结节的检出和诊断符合率,并总结不同影像学检查中的图像表现。结果超声造影检查对肝硬化肝内微小结节的诊断符合率显著高于增强CT检查,尤其对于小肝癌的诊断符合率更高(P<0.05)。超声造影36个肝癌病灶均表现为"快进快出"特征,其中30个病灶在动脉期病灶内表现为造影剂呈球形快速填充,门脉期提前廓清,而在延迟期病灶完全廓清呈低回声改变,6个病灶在动脉期表现为环状向心性快速填充,门脉期至实质期始终同步廓清;而24个增生性结节病灶中有8个在动脉期呈现快速球形填充,在门脉期提前廓清,呈"快进快出"特征;5个肝血管瘤病灶中3个在动脉期表现为向心性增强,门脉期或延迟期缓慢廓清。增强CT检查中,35个肝癌病灶33个在动脉期呈现明显强化,2个未见明显强化,所有病灶均于门脉期和平衡期分别逐渐消退;24个增生性结节病灶在动脉期表现为中度强化,在门脉期呈现高度强化;4个肝血管瘤病灶在动脉期表现为轻度强化,在门脉期持续等强度强化,而延迟期呈现高度强化。结论超声造影对肝硬化患者肝内微小结节病灶诊断符合率显著高于增强CT患者,尤其是对于小肝癌的诊断,超声造影检查诊断更为优势。

Objective To explore the diagnostic value of contrast-enhanced ultrasonography and enhanced CT in the diagnosis of intrahepatic micro nodules in the context of cirrhosis.Methods 60 patients with cirrhosis who were treated in our hospital from June 2017 to January 2019 were en rolled in the study.All patients underwent contrast-enhanced ultrasonography and enhanced CT.detection rate and diagnostic coincidence rate of different examinations in the diagnosis of in the diagnosis of intra hepatic micro nodules of patients with cirrhosis were compared.Image features in different examinations were summarized.Results The diagnostic coincidence rate of contrast-enhanced ultrasonography for intrahepatic micro nodules in the context of cirrhosis was significantly higher than that of enhanced CT,especially for small hepatocellular carcinoma(P<0.05).In contrast-enhanced ultrasonography,36 lesions of liver cancer showed the characteristics of"fast-forward and fast-out".Among them,there were 30 lesions,in which the contrast medium was filled quickly in a spherical shape,the lesions in the portal phase were clea red in advance,and the lesions were completely clea red in the delayed phase,showing the change of low echo.And there were 6 lesions in which the contrast medium was filled quickly in annular and centripetal shape in the arterial phase,and the lesions were always cleared synchronously from the portal phase to the nephrographic phase.In the 24 hyperplastic nodular lesions,there were 8 lesions,in which contrast medium was filled quickly in a spherical shape,the lesions in the portal phase were clea red in advance,showing the cha racteristics of"fast-forwa rd and fast-out".In the 5 lesions of hepatic hemangioma,3 lesions showed an enhancement of centripetally in the arterial phase,and the lesions were slowly cleared in portal vein phase or delayed phase.In the enhanced CT examination,33 lesions of 35 liver cancer lesions showed obvious enhancement in the a rterial phase and 2 lesions were not significa ntly enhanced.All lesions gradually subsided in the portal and equilibrium phases.24 hyperplastic nodula r lesions showed moderate enhancement in the arterial phase and high enhancement in the portal phase,4 lesions of hepatic hemangioma showed mild enhancement in the a rterial phase and continued enhancement with equal strength in the portal phase,and showed high enhancement in the delayed phase.Conclusion The diagnostic coincidence rate of contrast-enhanced ultrasonography for intrahepatic micronodules in the context of cirrhosis was significantly higher than that of enhanced CT.Especially for the diagnosis of small hepatocellular carcinoma,the diagnosis of cont rast-enhanced ultrasonography is more advantageous.