超声造影与增强磁共振显像早期诊断肝硬化伴小肝癌的应用研究

目的 探讨肝硬化背景下超声造影(contrast-enhanced ultrasound CEUS)与增强磁共振显像(MR)对小肝癌(≤2.0cm)的早期诊断和鉴别诊断的差异性及临床应用的互补性.方法 临床观察45例伴有肝硬化的肝占位病变患者,术前行CEUS及增强MR检查,分别记录病灶检出个数、增强形式及诊断结果.所有病灶均经手术切除或穿刺病理证实,对两项检查结果进行回顾性对比研究.结果 45例患者增强检查后,超声造影发现病灶69个,增强MR发现病灶58个,两项检查共检出病灶75个,病理诊断肝癌病灶41个.小肝癌在超声造影与增强MR增强模式存在交叉,其中以模式Ⅰ"快进快出"及模式Ⅱ"快进慢出"最典型,将其作为诊断肝硬化伴小肝癌的标准,二者对肝癌的诊断率分别为77.3%(58/75)和62.7%(47/75)(0.50＜P＜0.75).对于不典型增强形式下的小肝癌病灶二者的诊断率差异有统计学意义(0.025＜P＜0.05).结论 CEUS及增强MR对于肝硬化伴小肝癌病灶的诊断率相似.对于不典型增强病灶,CEUS与增强MR各有优势,存在对小肝癌及良性病灶的诊断差异.

Early diagnosis of small hepatocellular carcinoma in patients with liver cirrhosis using contrast-enhanced ultrasound and contrast-enhanced magnetic resonance

Objective To evaluate retrospectively the difference and complementary of contrastenhanced ultrasound (CEUS) and contrast-enhanced magnetic resonance (CEMR) in early diagnosis and differential diagnosis of small hepatocellular carcinoma (SHCC)(≤2.0 cm) in patients with liver cirrhosis.Methods Forty-five patients with space-occupying lesions in cirrhotic livers were included, who were referred to CEUS and CEMR before operations. Numbers as well as diagnosis results were recorded respectively,and all cases were confirmed by pathological examination. Results Seventy-five lesions were found after CEUS and CEMR,with 69 and 58 respectively. Forty-one lesions were diagnosed pathologically as SHCC by surgery or needle biopsy. Overlapping exited in enhanced mode between CEUS and CEMR.Most SHCC displayed as mode Ⅰ "fast-in and fast-out" and mode Ⅱ "fast-in and slow-out" in both examination,which can be considered as a reliable criterion. The diagnostic accuracy of CEUS and CEMR was 77. 3% (58/75) and 62. 7% (44/75) respectively (0. 50＜ P ＜0. 75). Differences of the diagnostic accuracy of SHCC with atypical enhanced mode between CEMR and CEUS were statistically significant.Conclusions There is no significant difference of diagnostic accuracy of SHCC between CEMR and CEUS.Both of these two examing procedure have its own advantages for atypical lesions, which accounts for its diagnostic difference of small SHCC and benign lesions.