肝硬化结节的CEUS表现及其临床意义

目的分析肝硬化结节CEUS表现及其转归,探讨CEUS对肝硬化结节的诊断价值。方法应用实时灰阶CEUS技术观察63例患者共113个肝硬化结节。结果 113个肝硬化结节CEUS表现分为8种:①三相一致,73个病灶(73/113,64.60%);②缺损-一致,20个病灶(20/113,17.70%);③快进快出,4个病灶,(4/113,3.54%);④快进慢出,4个病灶(4/113,3.54%);⑤一致-快出,4个病灶(4/113,3.54%);⑥缺损-快出,4个病灶(4/113,3.54%);⑦低增强慢出,2个病灶(2/113,1.77%);⑧三相缺损,2个病灶(2/113,1.77%)。CEUS随访中8个病灶声像图发生变化,最终3个转变为恶性。结论 CEUS表现为"三相一致"的肝硬化结节预后较其他型相对安全;CEUS表现为动脉相"缺损"或晚期相"快出"的肝硬化结节相对较不稳定,需引起高度重视;少数肝硬化结节CEUS表现为类恶性,是导致CEUS出现假阳性的主要原因。

Enhancement patterns and clinical value of CEUS in cirrhosis nodules

Objective To observe the enhancement patterns and the prognosis of cirrhosis nodules,and to evaluate the diagnostic value of CEUS for cirrhosis nodules.Methods Totally 113 cirrhosis nodules in 63 patients were examined by real time gray-scale CEUS.Results The enhancement patterns of CEUS were classified as the following: ①Simultaneous isoecho with the liver,64.60%(73/113) lesions.②Delayed enhancement in portal phase and then became the isoecho in late phase,17.70%(20/113) lesions.③Early arterial enhancement,followed by washout in portal and/or late phases,3.54%(4/113) lesions.④Early arterial enhancement without washout during the portal/late phases,3.54%(4/113) lesions.⑤Simultaneous isoecho with the liver in arterial phase,washed out hypo-echo in portal and/or late phase,3.54%(4/113).⑥Delayed enhancement in portal phase,washed out and hypo-echo in late phase,3.54%(4/113).⑦Hypovascularity in the arterial phase,without washout during the portal/late phases,1.77%(2/113) lesions.⑧No perfusion in any phase,1.77%(2/113) lesions.Of these lesions,8 with sonograms changes were followed up by CEUS,and 3 of them developed into malignant tumor during the observation period.Conclusion The cirrhosis nodules with simultaneous enhancement pattern and presenting isoecho with the liver are relatively safer than other lesions.The cirrhosis nodules with delayed enhancement in portal phase or washout in portal and/or late phases are often unstable,and high attention must be paid to them.Few cirrhosis nodules behave like malignant tumor during CEUS,which is the main source of false-positive of CEUS.