消化系神经内分泌肿瘤超声造影表现特征分析

目的分析消化系统神经内分泌瘤(NET)原发病灶及肝转移灶超声造影(CEUS)表现特征,评价CEUS诊断消化系NET的价值。方法 2005—2009年Charité医院收治90例经手术和(或)穿刺活检病理确诊的消化系NET患者。回顾性分析79个消化系NET原发病灶、510个肝转移灶常规超声表现及69个原发病灶、70个肝转移灶CEUS表现。结果常规超声示79个消化系NET原发病灶以低回声和混合回声为主,69.7%(23/33)的小肠NET原发病灶和64.3%(18/28)的胰腺NET原发病灶内部回声不均,27.8%(22/79)的消化系NET原发病灶含部分液化区。CEUS示69个消化系NET原发病灶中93.3%(63/69)血供丰富,72.5%(50/69)呈向心性增强。常规超声示510个肝转移灶中39.1%(199/510)表现为低回声,34.1%(174/510)为高回声,23.7%(121/510)为混合回声;32.7%(167/510)的肝转移灶周围存在声晕。CEUS示肝转移灶中70.0%(49/70)为向心性增强,27.1%(19/70)为快速整体增强,呈离心充盈的仅占2.9%(2/70);78.7%(55/70)的肝转移灶在60s内开始出现增强消退。结论消化系NET原发病灶及肝转移灶具有特征性CEUS表现。CEUS可作为NET影像诊断学方法之一。

Characterization of neuroendocrine tumors in the digestive system with contrast-enhanced ultrasonography

Objective To characterize the features of neuroendocrine tumors（NET）in the digestive system and their liver metastases with contrast-enhanced ultrasound（CEUS）and to evaluate its role of diagnosis.Methods Ninty patients with histologically proven NET,who were treated in University Hospital Charité during 2005-2009,were enrolled in this retrospective study.The ultrasound features of primary NET and their liver metastasis were analyzed on both conventional ultrasound（79 and 510 respectively）and CEUS（69 and 70 respectively）.Results The primary NET（size from 10 mm to 240 mm）appeared mainly hypoechoic and mixed-echoic.69.7%（23/33）of the small intestinal lesions and 64.3%（18/28）of pancreatic lesions showed heterogeneous echogenicity.Cystic area was found in 27.8%（22/79）of all the primary tumors.93.3%（63/69）of NET were hypervascular in CEUS and 72.5%（50/69）showed centripetal enhancement.Within the 510 evaluated liver metastases,39.0%（199/510）were hypoechoic,34.1%（174/510）were hyperechoic and 23.7%（121/510）appeared as mixed-echoic.Additionally,halos were detected in 32.7%（167/510）of the liver metastases.During CEUS the microbubbles flowed centripetally in 70.0%（49/70）of cases,27.1%（19/70）enhanced rapidly in the whole lesion,and only 2.9%（2/70）enhanced centrifugally.The signal intensity in 78.7%（55/70）of liver metastases began to reduce within 60 s.Conclusion Real-time CEUS shows the characteristics of NET