实时灰阶超声造影对肝硬化定量诊断的初步探讨

Real time gray-scale ultrasound contrast imaging in quantitative diagnosis of liver cirrhosis

目的 利用新型超声造影剂及匹配成像技术观察肝硬化患者的肝动脉、门静脉以及肝脏实质的灌注规律 ,探讨对肝硬化定量化诊断的意义。方法 2 6例经手术或穿刺证实为肝硬化的患者入选本研究 ,另 8例无任何肝脏病史或肝病临床表现者作为正常肝对照组 ,采用第二代超声造影剂SonoVue以及TechnosDU 6CnTi实时超声造影成像技术 ,行实时灰阶超声造影检查。造影剂注射方法分两种 :其中 11肝硬化患者及 8例正常肝者采用慢注法 ,另 15例肝硬化患者采用团注法。结果 慢注法肝硬化的门静脉显影时间与肝实质增强峰值时间均较正常肝显著延长 ( 3 9.3 6± 11.89)svs ( 3 0 .0 0± 6.76)s,( 60 .91± 15 .67)svs ( 41.13± 6.49)s ,P <0 .0 5 ;肝动脉显影时间、达峰值时间以及门静脉达峰值时间均与正常组无显著差异。团注法的肝动脉、门静脉平均显影时间 ,达峰值时间以及肝实质增强峰值时间均比慢注法提前 ,分别为 ( 14 .80± 4.96)s ,( 2 6.67± 6.92 )s,( 2 2 .80± 5 .87)s ,( 3 3 .87± 6.0 6)s ,( 3 5 .93± 9.71)s ;除肝动脉时相外 ,余各时相均有显著性差异 ,P <0 .0 5。本组肝硬化患者的上述时相均与患者的Child Paugh分级无相关性。 结论 本研究初步结果显示利用造影超声有助于肝硬化的诊断 ,但各时相显示时?

Objective To observe the hepatic artery, hepatic vein and portal vein perfusion pattern of liver cirrhosis using new contrast agent and real time gray scale contrast tuned imaging (CnTi) and to investigate the quantitative diagnostic value in liver cirrhosis. Methods Twenty six cases of liver cirrhosis proven by operation or biopsy were enrolled in our study while eight cases of non cirrhotic patients with neither liver disease history nor clinical signs served as controls. Contrast agent SonoVue, Technos DU6 and CnTi technology were used. The hepatic artery, hepatic vein, portal vein and liver parenchyma arrival time and peak time after the contrast agents injection were observed. Eleven cirrhotic cases and 8 normal controls were given continuous infused and 15 liver cirrhosis patients were given bolus injected. Results Patients with cirrhosis after continuous infusion showed a much later onset of enhancement of portal vein [arrival time: (39.36±11.89) s and peak enhancement of liver parenchyma (60.91±15.67) s than normal controls (30.00±6.76) s and (41.13±6.49) s, P <0.05]. The hepatic artery arrival time and peak time, the portal vein peak time were not significantly different in cirrhotic and control cases. For cirrhosis patients, the arrival time and peak time of portal vein and the peak enhancement of liver parenchyma were markedly later after bolus injection compared with continuous infusion [ (39.36±11.89) s, (47.45±13.81) s, (60.91±15.67) s vs (26.67±6.92) s, (33.87±6.06) s, (35.93±9.71) s, P <0.05]. The arrival times and peak times of patients with cirrhosis were not related to their Child grades. Conclusion Our preliminary study suggests that the using of ultrasound contrast agents has potential as a non invasive diagnostic modality for cirrhosis. Furthermore, establishment of the cut off times of all phases should be dependent on the methods of contrast agents injection.