超声造影在肝脏局灶性病变诊断及治疗中的应用价值

The application value of contrast-enhanced ultrasound in the diagnosis and treatment of focal liver lesions

目的探讨在肝脏局灶性病变诊断及治疗中超声造影的应用价值。方法利用低机械指数灰阶超声造影检查75例患者81个肝脏局灶性病变,观察病灶在各时相的造影剂灌注特征,记录病变开始增强时间、开始减退时间、增强持续时间并做出对比分析。结果良恶性病灶动脉期、门脉期及延迟期造影剂灌注模式有明显不同,恶性病变多表现为"快进快出",其开始增强时间为(16.41±3.21)s,开始消退时间为(76.35±16.25)s。良性病变多表现为"快进慢出"和"慢进慢出",其开始增强时间为(24.35±6.22)s,开始消退时间为(234.41±39.64)s,增强持续时间为(186.43±46.64)s。恶性病变开始增强时间、开始减退时间、增强持续时间均早于良性病变(P<0.05)。良性病灶动脉期造影增强方式也有特征性表现,肝血管瘤多表现为周边环状、结节状增强,局灶性结节性增生多为离心性增强。结论超声造影能准确地反映肝脏局灶性病变动态血流灌注,在肝脏良恶性肿瘤鉴别诊断及治疗方面有重要的临床应用价值。

Objective To explore the value of contrast-enhanced ultrasound in the diagnosis and treatment of focal liver lesions.Methods Low-mechanical index gray-scale contrast-enhanced ultrasound was used to detect 81 focal liver lesions in 75 patients.The perfusion characteristics of contrast media in different phases of the lesions were observed.The arrival time,wash-out time and duration of the enhancement of the lesions were recorded and were compared analysis.Results The contrast media perfusion patterns of benign and malignant lesions in arterial phase,portal phase and delay period were significant differences.Most of the malignant lesions appeared as'fast in,fast out'.The arrival time was(16.41±3.21)s,wash-out time was(76.35±16.25)s.Whereas the benign lesions appeared as'fast in,slow out'and'slow in,slow out'.The arrival time was(24.35±6.22)s,wash-out time was(234.41±39.64)s,the enhancement duration was(186.43±46.64)s.The arrival time,wash-out time and enhancement duration of malignant lesions were earlier than benign lesions(P<0.05).The enhancement pattern of arterial period in benign lesions was also characteristic manifestations.Most hepatic hemangioma showed peripheral annular and nodular enhancement,while most focal nodular hyperplasia showed centrifugal enhancement.Conclusion Contrast-enhanced ultrasound can accurately reflect the dynamic blood perfusion of focal liver lesions,and has important clinical value in the differential diagnosis and treatment of benign and malignant liver tumors.