肝局灶性病变超声造影反向脉冲谐波显像的临床研究

Clinical study on pulse-inversion harmonic sonographic imaging of focal hepatic lesions

目的 探讨不同肝局灶性病变在超声造影反向脉冲谐波显像时的动态灌注过程及其特征。方法 对 7例肝细胞性肝癌 ,6例转移性肝肿瘤 ,1例腺瘤 ,6例血管瘤 ,1例局灶性脂肪浸润 ,3例局灶性慢性炎症 ,1例多房囊肿共 2 5个肝局灶性病变进行超声造影反向脉冲谐波动态显像 ,观察病灶内及肝实质的灌注过程。结果 2 5例均观察到动脉期 ( 5～ 2 4s)、门脉期 ( 19～ 85s)、实质期 ( 2 0 0～ 3 2 0s)。 7例肝细胞性肝癌均为肝动脉期完全显著增强 ;5例转移癌为门脉期增强 ,2例在实质期发现更多病灶 ;6例血管瘤均显示出特征性的填充式增强 ;2例慢性炎症及 1例脂肪浸润未见增强 ;1例腺瘤为门脉期显著增强 ;1例多房囊肿则为实质期低回声缺损。结论 超声造影反向脉冲谐波显像可清晰显示肝局灶性病变及肝实质的动态灌注过程 ,对诊断和鉴别诊断具有明确的临床应用价值。

Objective To characterize the dynamic contrast enhancement in focal hepatic lesions with pulse inversion harmonic(PIH) ultrasonographic imaging. Methods Twenty five patients with 25 known focal hepatic lesions were examined with PIH mode imaging after an intravenous administration of SonoVue. The enhancement duration of focal hepatic lesions and normal parenchyma were used to evaluate the contrast effects. Results Three dynamic phases appeared sequentially during the contrast process, consisting of arterial phase(5-24 s), portal phase(19-85 s), parenchymal phase(200-320 s). Remarkable arterial enhancement was found in all 7 cases of hepatic cell cancer. Of 6 metastases, portal enhancement was found in 5 cases and more lesions were found in parenchymal phase with 2 cases. Centripetal filling in the lesions with intratumoral enhancement was only seen in all 6 cases of hemangiomas. Conclusions Contrast enhancement PIH imaging has proved an effective tool in characterizing liver tumors.