肝脏孤立性炎性病灶与原发性肝癌的超声造影鉴别诊断研究

Differential diagnosis of solitary inflammatory liver lesion and hepatocellular carcinoma with contrast enhanced ultrasound

目的分析肝脏孤立性炎性病灶的超声造影增强模式,寻找与原发性肝癌的鉴别要点。方法回顾性分析2006~2013年42例病理确诊为肝脏炎性病灶的超声造影增强模式,并与30例同期病理诊断为HCC的超声造影增强模式等进行对比分析。结果肝脏孤立性炎性病灶的CEUS增强模式主要表现为动脉期片状强化(57.1%)及环状强化(23.8%);形态多不规则(64.3%);峰值时边界不清晰(69.0%);实质期病灶呈缓慢廓清(69.0%),廓清边界不清晰(61.9%);病灶内坏死区形态规则(71.0%)。HCC动脉期表现为团状强化(86.7%);形态规则(66.7%);峰值时边界清晰(90.0%);实质期快速廓清(56.7%);廓清边界清晰(76.7%);坏死区形态不规则(75.0%)。炎性病灶与HCC动脉期增强模式、形态、边界、实质期廓清速度及坏死区形态差异具有统计学意义(P<0.05)。结论 CEUS可为肝脏孤立性炎性病灶提供重要的诊断信息,有助于与HCC进行鉴别诊断。

Objective To investigate the perfusion features of solitaryinflammatory liver lesion(ILL) with contrast enhanced ultrasound(CEUS), and try to find out the key points of differential diagnosis between ILL and hepatocellular carcinoma(HCC). Methods In 2006 to 2013, 42 patients with and 30 patients with hepatocellular carcinoma(HCC) which finally diagnosed by pathology were enrolled in this study. The CEUS perfusion features of ILL and HCC were compared and analyzed retrospectively. Results The CEUS perfusions features of ILL mainly displayed as a patchy(57.1%), rim like(23.8%) enhancement and an irregular shape(64.3%) in arterial phase, and a poorly defined margin(69.0%) in peak time, and also showed a slowly washout(69.0%) and a poorly defined(61.9%) margin in parenchymal phase. The shape of necrosis was regular(71.0%) in ILL. On the contrast, the features of HCC displayed a nodular(86.7%) enhancement and a regular shape(66.7%) in arterial phase and a well-defined margin(90.0%) in peak time, and also showed a rapid washout(56.7%) and a well-defined margin(76.7%) in parenchymal phase. The shape of necrosis was irregular(75.0%) in HCC. The perfusion features in arterial phase, time of washout and shape of necrosis in parenchymal phase showed significant difference between the two groups(P < 0.05). Conclusions CEUS could provide significant information for the diagnosis of ILL, and it washelpful for the differential diagnosis between ILL and HCC.