肝血管平滑肌脂肪瘤的超声造影与增强螺旋CT对比研究

目的 探讨实时超声造影对肝血管平滑肌脂肪瘤的术前诊断意义.方法 19例入组患者共计21个手术切除病理学确诊的肝血管平滑肌脂肪瘤,5例采用脉冲反向谐波造影技术,14例采用对比脉冲序列造影技术,机械指数＜0.2,2.4 ml造影剂SonoVue团注.将超声造影与增强螺旋CT的术前诊断与手术后病理结果进行比较分析.结果 超声造影15个肿瘤诊断为血管平滑肌脂肪瘤,误诊为肝癌1个、肝腺瘤2个、肝血管瘤1个,2个考虑良性肿瘤但不能进一步分型,超声造影术前诊断准确率为71.4%.增强CT检查8个肿瘤诊断为血管平滑肌脂肪瘤,误诊为肝癌7个、脂肪肉瘤1个、脂肪瘤2个、肝腺瘤1个、血管瘤2个.增强CT的术前诊断准确率为38.1%,低于实时超声造影(P＜0.05).结论 实时超声造影能够准确反映大多数肝血管平滑肌脂肪瘤的血管分布和血流灌注特点,对肝血管平滑肌脂肪瘤的术前诊断准确率高于增强CT.     

肝血管平滑肌脂肪瘤的超声造影与增强螺旋CT对比研究

Objective To observe the perfusion pattern of hepatic angiomyolipomas using contrastenhanced ultrasound(CEUS) and compare diagnostic efficacy of contrast-enhanced ultrasound with contrastenhanced helical CT(CECT).Methods Nineteen patients with 21 resected and pathologically proven hepatic angiomyolipomas were included in this study.Low mechanical index (mechanical index less than 0.2) realtime CEUS was performed in nineteen patients (5 patients with pulse inversion harmonic, 14 patients with contrast pulse sequencing, CPS) after 2.4ml bolus injection of contrast agent SonoVue.CECT was performed using 16-slice helical CT and contrast agent Ultravist.The diagnostic performance was calculated by considering histologic results as the reference standards.Results Fifteen tumors were correctly diagnosed as hepatic angiomyolipomas,4 tumors were misdiagnosed (including 1 hepatocellular carcinoma,2hepatic adenomas, 1 hemangioma) and 2 tumors were characterized as benign lesions by CEUS.Eight tumors were correctly diagnosed as hepatic angiomyolipomas, 13 tumors were misdiagnosed (including 7hepatocellular carcinoma, 1 liposarcoma, 2 lipomas, 1 hepatic adenomas, 2 hemangiomas) by CECT.The preoperative diagnostic accuracy was 71.4% for CEUS and 38.1 % for CECT(P＜0.05 ).Conclusions CEUS can demonstrate typical imaging characteristics of most hepatic angiomyolipomas, and has higher diagnostic performance than CECT in characterization of hepatic angiomyotipomas.     

肝血管平滑肌脂肪瘤超声及CT影像学对比分析

目的探讨肝血管平滑肌脂肪瘤（HAML）的影像学表现及其与病理组织学相关性。方法回顾性分析我院近3年经病理诊断的6例11灶HAML患者的常规超声、超声造影及CT表现，并对照病理组织学进行分析。结果6例HAML中脂瘤型2例，肌瘤型1例，混合型3例。脂瘤型、肌瘤型、混合型3种类型超声表现分别为高回声、低回声及混合回声，相应CT平扫表现为含脂肪成分的极低密度影、软组织密度影及混杂密度影。3例行超声造影检查动脉期均有不均匀或均匀强化，2例脂瘤型延迟期仍稍高于周围肝实质，1例混合型有轻度退出。增强CT（CECT）所有病灶动脉期均有不均匀或均匀强化，门脉期4例（脂瘤型2例，混合型2例）高于周围肝实质，2例（肌瘤型1例，混合型1例）低于周围肝实质。超声诊断良性2例，恶性1例，性质不确定3例；CT诊断良性3例，性质不确定3例。结论因脂肪组织、平滑肌及血管3种成分比例及分布不同，HAML影像学表现呈多样性，超声造影及增强CT有助于良恶性诊断，但部分病例仍难以除外恶性，确诊须依据肝穿刺活检或术后病理检查。     

肝血管平滑肌脂肪瘤的超声造影表现

目的 探讨肝血管平滑肌脂肪瘤(angiomyolipoma,AML)的超声造影表现.方法 回顾性分析9例经病理确诊的肝AML患者共10个病灶的常规超声和超声造影表现.超声造影采用SonoVue和对比脉冲序列成像技术.结果 常规超声7个病灶呈现混合回声,即明显高回声伴片状低回声;3个病灶呈明显高回声.彩色多普勒超声检查所有病灶均测得动脉血供,且血供丰富或较丰富或稀少,阻力指数平均0.53±0.10(0.48～0.62).超声造影显示9个病灶动脉期均呈高增强;门脉期5个为等增强,1个为高增强,3个为低增强;延迟期6个为等增强,3个为低增强.1个病灶三期均为低增强.结论 超声造影上肝AML的增强表现具有一定特征性,可用于提示诊断,但仍需积累更多经验.     

肝血管平滑肌脂肪瘤的超声造影表现

Objective To investigate the features of hepatic angiomyolipoma(AML) on contrast enhanced ultrasound (CEUS). Methods Ten pathologically proved AML lesions in 9 patients were evaluated by using baseline ultrasound and CEUS. CEUS was performed with contrast pulse sequencing technique and the contrast agent of SonoVue. Results On baseline ultrasound, 7 lesions exhibited mixed echoic,which was obvious hyperechoic combined with partly of hypoechoie; 3 lesions exhitited obvious hypereehoic. On color Doppler flow imaging artery signals were detected in all lesions. And the lesions had plenty or slightly plenty of artery supply,with resistive index about 0.53 4±0.10 (0.48~0.62). On CEUS, in the arterial phase, 9 lesions exhibited hyper-enhanced. In the portal phase, 5 lesions exhibited iso-enhancement,1 lesion was slightly hyper-enhancement and 3 lesions was hypo-enhancement. In the late phase 6 lesions were iso-enhancement and 3 lesions were hypo-enhancement. One lesion was all hypo-enhancement in all three phases. Conclusions There are some characteristic manifestations of hepatic AML in CEUS, which are helpful for the diagnosis of hepatic AML in a way,but we still need more experiences.     

肝血管平滑肌脂肪瘤的超声造影表现

Objective To investigate the features of hepatic angiomyolipoma(AML) on contrast enhanced ultrasound (CEUS). Methods Ten pathologically proved AML lesions in 9 patients were evaluated by using baseline ultrasound and CEUS. CEUS was performed with contrast pulse sequencing technique and the contrast agent of SonoVue. Results On baseline ultrasound, 7 lesions exhibited mixed echoic,which was obvious hyperechoic combined with partly of hypoechoie; 3 lesions exhitited obvious hypereehoic. On color Doppler flow imaging artery signals were detected in all lesions. And the lesions had plenty or slightly plenty of artery supply,with resistive index about 0.53 4±0.10 (0.48~0.62). On CEUS, in the arterial phase, 9 lesions exhibited hyper-enhanced. In the portal phase, 5 lesions exhibited iso-enhancement,1 lesion was slightly hyper-enhancement and 3 lesions was hypo-enhancement. In the late phase 6 lesions were iso-enhancement and 3 lesions were hypo-enhancement. One lesion was all hypo-enhancement in all three phases. Conclusions There are some characteristic manifestations of hepatic AML in CEUS, which are helpful for the diagnosis of hepatic AML in a way,but we still need more experiences.     

肝血管平滑肌脂肪瘤的超声造影表现

Objective To investigate the features of hepatic angiomyolipoma(AML) on contrast enhanced ultrasound (CEUS). Methods Ten pathologically proved AML lesions in 9 patients were evaluated by using baseline ultrasound and CEUS. CEUS was performed with contrast pulse sequencing technique and the contrast agent of SonoVue. Results On baseline ultrasound, 7 lesions exhibited mixed echoic,which was obvious hyperechoic combined with partly of hypoechoie; 3 lesions exhitited obvious hypereehoic. On color Doppler flow imaging artery signals were detected in all lesions. And the lesions had plenty or slightly plenty of artery supply,with resistive index about 0.53 4±0.10 (0.48~0.62). On CEUS, in the arterial phase, 9 lesions exhibited hyper-enhanced. In the portal phase, 5 lesions exhibited iso-enhancement,1 lesion was slightly hyper-enhancement and 3 lesions was hypo-enhancement. In the late phase 6 lesions were iso-enhancement and 3 lesions were hypo-enhancement. One lesion was all hypo-enhancement in all three phases. Conclusions There are some characteristic manifestations of hepatic AML in CEUS, which are helpful for the diagnosis of hepatic AML in a way,but we still need more experiences.     

肝血管平滑肌脂肪瘤的超声造影表现

Objective To investigate the features of hepatic angiomyolipoma(AML) on contrast enhanced ultrasound (CEUS). Methods Ten pathologically proved AML lesions in 9 patients were evaluated by using baseline ultrasound and CEUS. CEUS was performed with contrast pulse sequencing technique and the contrast agent of SonoVue. Results On baseline ultrasound, 7 lesions exhibited mixed echoic,which was obvious hyperechoic combined with partly of hypoechoie; 3 lesions exhitited obvious hypereehoic. On color Doppler flow imaging artery signals were detected in all lesions. And the lesions had plenty or slightly plenty of artery supply,with resistive index about 0.53 4±0.10 (0.48~0.62). On CEUS, in the arterial phase, 9 lesions exhibited hyper-enhanced. In the portal phase, 5 lesions exhibited iso-enhancement,1 lesion was slightly hyper-enhancement and 3 lesions was hypo-enhancement. In the late phase 6 lesions were iso-enhancement and 3 lesions were hypo-enhancement. One lesion was all hypo-enhancement in all three phases. Conclusions There are some characteristic manifestations of hepatic AML in CEUS, which are helpful for the diagnosis of hepatic AML in a way,but we still need more experiences.     

肝血管平滑肌脂肪瘤的超声造影表现

Objective To investigate the features of hepatic angiomyolipoma(AML) on contrast enhanced ultrasound (CEUS). Methods Ten pathologically proved AML lesions in 9 patients were evaluated by using baseline ultrasound and CEUS. CEUS was performed with contrast pulse sequencing technique and the contrast agent of SonoVue. Results On baseline ultrasound, 7 lesions exhibited mixed echoic,which was obvious hyperechoic combined with partly of hypoechoie; 3 lesions exhitited obvious hypereehoic. On color Doppler flow imaging artery signals were detected in all lesions. And the lesions had plenty or slightly plenty of artery supply,with resistive index about 0.53 4±0.10 (0.48~0.62). On CEUS, in the arterial phase, 9 lesions exhibited hyper-enhanced. In the portal phase, 5 lesions exhibited iso-enhancement,1 lesion was slightly hyper-enhancement and 3 lesions was hypo-enhancement. In the late phase 6 lesions were iso-enhancement and 3 lesions were hypo-enhancement. One lesion was all hypo-enhancement in all three phases. Conclusions There are some characteristic manifestations of hepatic AML in CEUS, which are helpful for the diagnosis of hepatic AML in a way,but we still need more experiences.     

肝血管平滑肌脂肪瘤的超声造影表现

Objective To investigate the features of hepatic angiomyolipoma(AML) on contrast enhanced ultrasound (CEUS). Methods Ten pathologically proved AML lesions in 9 patients were evaluated by using baseline ultrasound and CEUS. CEUS was performed with contrast pulse sequencing technique and the contrast agent of SonoVue. Results On baseline ultrasound, 7 lesions exhibited mixed echoic,which was obvious hyperechoic combined with partly of hypoechoie; 3 lesions exhitited obvious hypereehoic. On color Doppler flow imaging artery signals were detected in all lesions. And the lesions had plenty or slightly plenty of artery supply,with resistive index about 0.53 4±0.10 (0.48~0.62). On CEUS, in the arterial phase, 9 lesions exhibited hyper-enhanced. In the portal phase, 5 lesions exhibited iso-enhancement,1 lesion was slightly hyper-enhancement and 3 lesions was hypo-enhancement. In the late phase 6 lesions were iso-enhancement and 3 lesions were hypo-enhancement. One lesion was all hypo-enhancement in all three phases. Conclusions There are some characteristic manifestations of hepatic AML in CEUS, which are helpful for the diagnosis of hepatic AML in a way,but we still need more experiences.     

脉冲反向谐波实时超声造影与增强螺旋CT诊断肝占位病变的比较研究

目的 比较实时超声造影与增强螺旋CT显示肝占位病变血流灌注特点的能力，探讨超声造影在肝肿瘤鉴别诊断中的应用价值。方法 对109例经手术或超声引导穿刺活检病理确诊的肝占位（原发性肝癌61例，转移性肝癌15例，肝内胆管细胞癌5例，血管瘤12例，肝硬化增生结节5例，肝细胞腺瘤2例，胆管细胞腺瘤1例，局灶性结节增生3例，局灶性坏死4例，血管平滑肌脂肪瘤1例）术前分别进行实时超声造影和造影剂增强16层螺旋CT检查，将两种检查的术前诊断与术后病理结果进行比较分析。结果 超声造影漏诊原发性肝癌2例、转移性肝癌1例，误诊原发性肝癌5例、胆管癌1例、胆管腺瘤1例、肝硬化结节1例、血管瘤1例、局灶性结节增生1例。增强CT漏诊原发性肝癌3例、转移性肝癌2例、血管瘤1例、肝硬化增生结节1例，误诊原发性肝癌7例、胆管癌2例、胆管腺瘤1例、血管瘤3例、肝硬化结节2例、局灶性结节增生2例、局灶性坏死2例。超声造影诊断肝占位病变的检出率为97．25％，增强CT的检出率为93．58％；超声造影诊断肝肿瘤的准确性为90．83％，增强CT的准确性为82．57％。结论 实时超声造影对肝占位病变的诊断能力与增强螺旋CT相近，实时超声造影具有独立诊断价值，对于增强CT扫描阴性或未显示病灶血流灌注特点的病例，超声造影具有更重要的临床意义。     

低机械指数超声造影与增强螺旋CT诊断≤2 cm肝细胞癌的比较研究

目的 比较实时超声造影与增强螺旋CT对≤2 cm肝细胞癌的诊断能力,探讨实时超声造影诊断小肝癌的临床应用价值.方法 对117例经手术或超声引导穿刺活检病理确诊的≤2 cm肝细胞癌[病灶大小 0.5～2.0 cm,平均(1.43±0.34)cm],术前分别进行低机械指数实时超声造影(MI《0.19,反向脉冲谐波模式,造影剂为SonoVue)及增强螺旋CT检查,将两种检查的术前诊断与病理结果 进行比较分析.结果 超声造影未显病灶11例,增强螺旋CT未显示病灶27例,检出率分别为 90.6%(106/117)和 76.9%(90/117)(P《0.01).以病灶动脉相整体高增强,门脉相或延迟相消退为低增强为诊断标准,超声造影诊断≤2 cm肝细胞癌的准确性为 80.2%(85/106),增强螺旋CT为 65.6%(59/90)(P《0.05).结论 低机械指数实时超声造影对≤2 cm肝细胞癌的检出率和诊断准确性高于增强螺旋CT,提高了对小肝癌的诊断能力.     

具有肝硬化基础的肝内胆管细胞癌的超声造影及增强CT的增强模式分析

目的 探讨在肝硬化基础上的肝内胆管细胞癌的实时超声造影与增强螺旋CT的成像特征.方法 经病理确诊的胆管细胞癌并肝硬化的患者12例(手术切除11例,穿刺1例),11例采用对比脉冲造影技术,1例采用连续脉冲反向谐波造影技术,机械指数<0.2,2.4 mL造影剂SonoVue团注.将超声造影与增强CT的增强模式、术前诊断与病理结果进行对比分析.结果 超声造影动脉相5例(41.7%)为不均匀高增强,3例(25.0%)为均匀高增强,4例(33.3%)为周边环状增强.超声造影3例(25.0%)诊断为肝内胆管细胞癌,9例(75.0%)诊断为肝细胞癌.增强CT动脉期10例(83.3%)为不均匀强化,2例(16.7%)为环状强化.2例(16.7%)诊断为肝内胆管细胞,10例(83.3%)诊断为肝细胞癌.结论 肝硬化基础上的多数肝内胆管细胞癌实时超声造影与增强螺旋CT的增强模式与肝细胞癌类似,影像学鉴别诊断困难.     

超声造影与增强螺旋CT诊断肝硬化背景下≤2 cm结节样病灶的比较研究

目的 探讨超声造影(contrast-enhanced ultrasound,CEUS)与增强螺旋CT(contrast-enhanced helical computed tomography,CECT)对肝硬化背景下≤2 cm结节样病灶的诊断效能.方法 对72例81个肝硬化背景下常规超声检查可疑肝内小占化病变者(最大直径≤2 cm)进行CEUS和CECT检查(两者间隔时间≤2周),将两种检查的术前诊断与病理结果进行比较分析,评估两种检查方法的诊断效能.结果 81个病灶53个为肝细胞癌(HCC),26个增生结节,2个血管瘤.53个HCC中,CEUS 51个(96.2%)病灶动脉期呈高增强,CECT 41个(77.4%)病灶动脉期显示强化,CEUS与CECT在显示动脉期血供方面差异有统计学意义(P<0.01).以病灶动脉期呈高增强,门脉期或延迟期消退为低增强作为诊断HCC的标准,CEUS诊断小结节样病灶的敏感性、特异性、准确性分别为86.8%、82.1%、85.2%.CECT分别为73.6%、92.9%、80.2%(P>0.05).结论 CEUS对≤2 cm HCC动脉期血供的显示率高于CECT,CEUS对肝硬化背景下小结节样病灶的诊断能力与CECTT相似.     

胆囊癌的超声造影和增强螺旋CT对比分析

目的评价超声造影和增强螺旋CT对胆囊癌的诊断价值。方法对比分析26例经手术、病理证实的胆囊癌的超声造影和CT增强的影像表现。结果超声造影和CT增强具有相似的表现。26例中,厚壁型14例,肿块型7例,腔内结节型5例。超声造影确诊23例,CT增强确诊22例,两者结合确诊25例,误诊1例。结论超声造影和CT增强扫描对于胆囊癌的诊断均很敏感且价值很高,结合两者可提高该病的确诊率。     

肝肿瘤实时灰阶谐波超声造影与动态增强螺旋CT对照研究

目的 探讨实时灰阶谐波超声造影和动态增强螺旋CT对肝局灶性病变的诊断价值.方法 选择肝局灶性病变患者49例,共54个病灶.其中包括原发性肝癌29个,转移性肝癌4个,肝血管瘤11个,肝局灶性结节增生7个,肝硬化结节1个,肝脂肪浸润不均2个.分别进行实时灰阶谐波超声造影和动态增强螺旋CT检查,比较肝肿瘤在两种成像方法中的表现.结果 两种成像方法显示的肝肿瘤在不同时相的表现及在动脉相的增强类型相一致.超声造影鉴别诊断肝良恶性病变的敏感性、特异性和准确性分别为 90.9%（30/33）、90.5%（19/21）和 90.7%（49/54）;动态增强螺旋CT鉴别诊断肝良恶性病变的敏感性、特异性、准确性分别为 90.9%（30/33）、95.2%（20/21）和 92.6%（50/54）,二者鉴别肝局灶性病变良恶性的能力差异无显著性意义.结论 实时灰阶谐波超声造影和动态增强螺旋CT均能反映肝病变的血流动力学特性,均有助于肝肿瘤的鉴别诊断.     

实时超声造影与增强螺旋CT检出恶性肿瘤肝转移灶的临床研究

目的 比较常规超声、超声造影及增强CT对恶性肿瘤肝转移灶的检出能力。方法 应用超声造影剂SonoVue及反向脉冲谐波造影成像技术,对73例已确诊为恶性肿瘤并疑有肝转移的患者进行超声造影检查,与常规超声及增强CT结果进行比较。结果 常规超声在67例患者中检出176个转移灶,6例未显示病灶的患者超声造影后检出肝内转移灶,46例患者（63、0％）超声造影较常规超声多检出119个转移灶（P〈0、01）,89、9％的新检出病灶〈2cm,最小者0．3cm。13例患者超声造影较增强CT多检出44个亚厘米转移灶（P〈0．01）,2例患者增强CT较超声造影多检出3个转移灶。结论 超声造影能够明显提高恶性肿瘤肝内小转移灶的检出能力,对亚厘米转移灶的检出优于增强CT,超声造影对恶性肿瘤临床分期及治疗方案的选择有较高的应用价值。     

肝内胆管细胞癌超声造影与增强CT表现的对比研究

目的：对比分析肝内胆管细胞癌（Intrahepatic cholangiocarcinoma,ICC）超声造影（Contrast-enhanced ultrasound,CEUS）与增强CT（Contrast-enhanced computed tomography,CECT）的增强表现。方法：对32例经手术病理或肝穿活检证实为ICC的患者的CEUS和CECT检查资料进行回顾性分析,对比分析两者对ICC的增强程度及模式的不同。结果：CEUS和CECT术前正确诊断ICC的分别为24例（75％）和27例（84％）（P>0.05）,如果综合两者,其准确率达94%。动脉期ICC增强方式与病灶大小有一定关系：直径≤3 cm的ICC病灶6个,其中3个在CEUS和4个在CECT上表现为胃全瘤均匀性高增强;而26个直径>3 cm的病灶在CEUS和CECT上表现为不均匀性增强或环形增强的分别为26个和25个。两种大小的病灶动脉期增强方式的差异有统计学意义（P<0.05）,延迟期CEUS和CECT分别有7个和22个ICC为高增强、25个和10个为低增强,两种大小的病灶门脉期增强方式的差异无统计学意义（P>0.05）,但是CEUS上病灶更多表现为低增强。结论：CEUS和CECT的诊断能力无显著差异,CEUS同CECT一样可用于ICC的定性诊断,两者相互结合可进一步提高ICC的诊断率。动脉期ICC小病灶几乎均为全瘤均匀性高增强,而大病灶倾向于不均匀性增强或环形增强。延迟期CEUS上病灶消退倾向比CECT上明显。