肝硬化增生小结节的超声造影定量分析及在定性诊断中的意义

目的分析探讨在肝硬化背景下的增生小结节（SRNs）（直径≤3．0cm）超声造影（CEUS）的血流灌注模式和超声造影参数在其定量诊断中的意义,进一步探讨超声造影在SRNs（≤3．0cm）诊断中的应用价值。方法回顾性分析32例（46个病灶）经细针穿刺有病理结果的SRNs的超声造影灌注模式,对实时超声造影图像运用时间一强度曲线进行分析,并比较SRNs造影前后诊断率。结果超声造影SRNs呈4种灌注模式：模式（1）：26／46个（56．52％）,“同进同出”;模式（2）：16／46个（34．78％）,“慢进同出”;模式（3）：3／46个（6．52％）,“快进慢出”;模式（4）：1／46个（2．17％）,“无增强无退出”。上升支及下降支斜度、平均强度各参数在SRNs与肝硬化实质鉴别中有显著差异,峰值时间无显著差异。常规超声的诊断率为65．79％,超声造影的诊断率为88．37％。结论CEUS对SRNs检出率明显优于常规超声,可有效动态地评价SRNs的血管化程度,尤其对于常规超声扫描未显示的小病灶进行定性、定量诊断,同时对血流灌注特点进行分析,超声造影对有恶变倾向的SRNs的早期诊断具有更重要的临床意义。

Quantitative Analysis of Contrast Enhanced Ultrasonography in Regenerative Nodules in Liver Cirrhosis and Its Significance in Quantitative Diagnosis

Objective To analyze the enhance pattern and the echogenicity of small regenerative nodules(SRNs) in cirrhotic patients and to evaluate the diagnostic value on the cirrhotic SRNs by these parameters of contrast-enhanced ultrasound(CEUS).Then to investigate the value of CEUS in the quantitative diagnosis of SRNs.Methods Contract Tuned Imaging Real-time Sono Vue enhanced ultrasonography was performed on 42 patients with LSFLIs that had definite pathologic diagnosis.The imaging of CEUS was analyzed by the time-intensity curve using computer assisted software.Results The enhancement patterns were classified as the following four types:Type Ⅰ,26/46 lesions,"enhanced simultaneously and presented the isoecho with the liver";Type Ⅱ,16/46 lesions,"slow-in and become the isoecho in parenchymal phase";Type Ⅲ,3/46 lesions,"fast-in ans slow-out";Type Ⅳ,1/46,"no enhancement". Slope of upslope and decent,average intensity in SRNs had significant deviation with liver parenchyma.Time-to peak had no significant deviation with no liver parenchyma.The diagnosis of conventional sonography was 65.79%.The diagnosis of CEUS was 88.37%.Conclusion The diagnosis of CEUS was superior to conventional sonography.It could evaluate the degree of vascularization in SRNs effectively,especially regenerative nodules.The time-intensity curve in SRNs that conventional sonography could not found.CEUS could analyzed and diagnosed.CEUS might be important in SRNs diagnosis as malignant tentatively.