肝肿瘤实时超声造影的血流动力学分析

Hemodynamic analysis of real-time enhanced-ultrasonography in diagnosis of focal liver lesions

目的 探讨实时超声造影在肝肿瘤诊断中的价值。方法 对 2 9例患者共 3 4个肝内实质占位病变进行实时谐波超声造影检查 ,其中 16个原发性肝癌 ,4个转移性肝癌 ,9个肝血管瘤 ,5个局灶性结节性增生。结果 经超声造影后 ,3 4个病灶均有不同程度的增强并有不同的增强特点。肝癌表现多为整体快速增强 ,呈不均状 ,并在门脉期快速消退 ;肝血管瘤多呈周围向心性增强 ,呈环状或周围结节状 ,并持续较长时间 ;肝局灶性结节性增生表现为中央扩散型快速均匀增强 ,并充盈整个门脉期。如以肝肿瘤在动脉期增强而在门脉期减退呈低回声作为诊断肝癌的指标 ,则超声造影诊断肝癌的敏感性、特异性及准确性分别为 95 %(19/2 0 )、10 0 %(14 /14 )和 97%(3 3 /3 4)。结论 实时超声造影能反映不同肝肿瘤在不同时相上的不同表现 ,可帮助提高肝肿瘤超声诊断的准确性。

Objective To evaluate the value of real-time enhanced-ultrasonography (EUS) in the diagnosis of hepatic tumor. Methods Twenty-nine patients with 34 hepatic solid lesions were examined by real-time EUS,including 16 primary liver malignant tumors,4 metastatic liver tumors,5 focal nodular hyperplasias (FNH),and 9 hemangiomas. All the cases were confirmed by histopathology. The ultrasound unit (Esaote Megas) with real-time EUS technique was used. The contrast agent used was SonoVue (Bracco,Italy). Results After injection of SonoVue,all the lesions were variously enhanced on real-time ultrasonogram. A holistic inhomogeneous enhanced pattern with quick disappearing was mostly detected by real-time EUS in hepatic malignant tumors,a peripheral and centripetal enhanced pattern was mostly shown in hamangiomas,and a radial centrifugal enhanced pattern with homogeneity and quickly was observed in FNHs. If the lesions with enhancement in arterial phase and disappearing in portal phase after injection of SonoVue were regarded as a sign for malignant liver tumor,the sensitivity,specificity and accuracy in the diagnosis of liver cancer with real-time EUS were respectively 95%(19/20),100%(14/14) and 97% (33/34). Conclusions The dynamic enhanced fashions and various enhanced features in various hepatic tumors will be reflected by real time EUS,which improves the accuracy of ultrasonography in the diagnosis of liver tumors.