肝脏造影B超在合并其他消化道肿瘤肝占位中的应用

目的探讨肝脏造影B超在合并其他消化道肿瘤的肝占位中的应用。方法回顾性分析合并其他消化道肿瘤肝占位患者42例(50个病灶),回顾其超声常规检查及造影检查结果,并与术中术后结果进行比较。结果肝细胞肝癌病灶5个,均表现为动脉期快速灌注,门脉期及肝实质期表现为快速退出;肝转移性肝癌病灶16个,5个表现为动脉期均匀增强,11个表现为不均匀增强,12个在门静脉期及肝实质期表现为快速退出,4个表现为缓慢退出,肝血管瘤病灶13个,表现为动脉期及门脉期缓慢向心性增强,肝实质期也表现为增强,肝囊肿病灶16个,未见明显增强,恶性肿瘤均经过病理证实,肝血管瘤、肝囊肿均术中探查证实。结论超声造影对合并其他消化道肿瘤的肝占位中有较高的准确率,对该类患者的临床诊断有较大的指导价值,可指导术中诊疗方案及整体治疗方案,但确诊仍需结合其他检查或病理结果。     

超声造影在肝硬化背景下鉴别肝内结节样病灶的应用价值

目的探讨超声造影在肝硬化背景下鉴别肝内结节样病灶的应用价值。方法对64例肝硬化合并83个肝内结节样病灶患者进行超声造影,并比较不同病变的肝脏超声造影特点。结果 51个恶性结节样病灶中,1个病灶病理结果显示为ICC,造影表现为"快进快出"(2%),2个病灶病理结果显示为HCC,造影表现为"快进慢出"(4%),2个病灶病理结果显示为HCC,造影表现为"慢进快出"(4%),其余46个HCC造影后均在动脉期增强而在门脉期消退,呈"快进快出"模式(90%)。32个肝脏良性结节样病灶中,7个超声造影表现动脉期快速增强,延迟期缓慢消退,为"快进慢出"(22%),24个超声造影表现为"同进同出"(75%),还有1个表现为动脉期缓慢增强,延迟期缓慢消退,即"慢进慢出"(3%)。结论超声造影在肝硬化背景下对鉴别肝内结节样病灶具有重要的临床意义和应用价值。     

超声造影对脂肪肝低脂灶诊断的应用价值

目的:探讨实时超声造影技术对脂肪肝中低脂灶诊断价值。方法:对58例脂肪肝患者中肝内65个低脂灶进行超声造影检查,实时观察病灶的增强模式。结果:常规超声44个(67.7%)病灶诊断为低脂灶,呈低回声;超声造影检查63个(96.9%)病灶诊断为低脂灶,表现为动脉期、门脉期及延迟期呈等增强;2个(3.1%)病灶诊断为良性病变,考虑为低脂灶的可能性大,动脉早期呈一过性高增强,动脉期和门脉期呈等增强。常规超声诊断低脂灶符合率为67.7%,超声造影为96.9%。结论:超声造影有助于低脂灶的诊断和鉴别诊断,是除增强CT、MRI以外的可行的诊断方法。     

超声造影对肝脏局灶性病灶良恶性鉴别诊断的价值

目的 探讨实时超声影成像技术在肝脏局灶病灶鉴别诊断中的价值.方法 对40例患者共45个肝内实质性局灶性病灶进行实时谐波超声造影检查,分析其血流灌注特征。结果 原发性肝癌及肝转移癌多表现为动脉期呈快速均匀或不均匀的高增强,门脉期快速消退,呈等或低增强,延迟相病灶的增强信号消退更明显,呈低增强或黑洞征;肝血管瘤多表现为动脉相周边环状、结节状增强,门脉相增强信号继续向心性填充,延迟相无消退,呈均匀或不均匀高增强;肝硬化结节及不均匀脂肪肝表现为自动脉相至门脉相及延迟相与周围肝实质同步均匀性增强,病灶边界消失。结论 实时超声造影能反映不同肝脏病变血流灌注的特征,对肝脏局灶性病变的鉴别诊断有重要价值。     

超声造影鉴别肝血管瘤的优势分析

目的探讨肝血管瘤超声造影(contrast-enhanced ultrasonography,CEUS)表现。方法用Sono Vue造影剂对32例39个肝血管瘤进行超声造影检查,观察造影剂在动脉期、门脉期、延迟期的增强表现。结果 35个(35/39)病灶动脉期造影剂呈周围环状伴结节增强,门脉期造影剂缓慢向中央增强,32个病灶呈完全充填,5个病灶呈不完全充填,延迟期与周围肝实质期比呈相对高增强;2个病灶在三个时相均无增强。结论肝血管瘤的CEUS典型表现为动脉期病灶周边环形增强,门脉期向中央缓慢增强,延迟期呈相对高增强。     

超声造影在肝脏炎性假瘤诊断中的临床价值探讨

目的:探讨肝脏炎性假瘤的超声造影模式及其临床应用价值.方法:回顾分析32例肝炎性假瘤的超声造影灌注特点.结果:21例病灶各期无增强(Ⅰ型);6例病灶动脉期周边细线环状增强而内部无增强,门脉期及后期病灶整体呈无增强(Ⅱ型);2例病灶动脉期呈均匀高增强,后期持续稍高增强(Ⅲ型);3例病灶动脉早期强化并早于肝实质消退,呈快速廓清表现(Ⅳ型).结论:肝炎性假瘤的超声造影有多种灌注类型,病灶各期无增强是其典型表现,特异性较强,而快速廓清型与不典型肝癌难以鉴别,肝穿活检是必要的选择.     

浅谈超声造影对36例肝脏良恶性肿瘤的鉴别诊断分析

目的观察肝脏良恶性肿瘤在超声造影各期相的灌注特点,评价超声造影在肝脏良恶性肿瘤鉴别诊断中的应用价值.方法 应用超声造影技术对36例常规超声检查中发现的肝脏占位性病变患者进行超声造影检查.结果 肝脏良恶性肿瘤病变增强的动态时相变化如下:1.恶性肿瘤患者病灶增强开始时间、减退时间均早于良性肿瘤患者(P<0.05);2.肝脏良恶性肿瘤造影后3个时相增强方式有所不同;3.肝脏恶性肿瘤表现为快进快出,良性肿瘤表现为慢进慢出.结论 超声造影能够准确地反映病灶的血流灌注情况,揭示不同肿瘤的增强特征,有助于肝脏良恶性肿瘤的鉴别诊断.     

超声造影对肝硬化增生癌变的研究

目的 通过超声造影(contrast-enhanced ultrasound,CEUS)观察肝硬化背景下局灶性病变(FLL)的灌注表现,探讨增生癌变(DN-Ca)的增强特征及诊断价值.方法 66例临床及影像学诊断为肝硬化者常规超声检查发现66灶1 cm～3 cm局灶性病变,行Sonovue实时灰阶超声造影(CEUS)检查.采用18G粗针穿刺活检,尤对同一结节内的不同增强区域分别取材行组织病理学检查.本文重点分析DN癌变超声造影表现及与肝细胞肝癌(HCC)的鉴别.结果 CEUS显示37灶整体增强,29灶部分增强.最终确诊DN癌变21灶、HCC 45灶.DN癌变21灶动脉期或门脉期表现为结节小部分区域增强,延迟期不同程度退出,结节其余部分与肝脏同步增强或延迟增强,少数23.8%(5/21)延迟期较肝脏提前退出.HCC的45灶中82.2%(37/45)动脉期或门脉期表现为整体增强,17.8%(8/45)不均匀增强,中心区呈不规则无回声;延迟期100%(45/45)退出.穿刺活检组织病理学证实21灶DN癌变动脉期增强区域为癌变区域,未增强区域为肝细胞增生;HCC37灶动脉期增强区为HCC,3灶动脉期无增强区为坏死液化,5灶轻度增强区为脂肪变性表现.结论 超声造影可灵敏反映肝硬化背景下局灶性病变病理组织学特征,从而有望对DN癌变做出早期诊断,重视超声造影下增强区域取材活检可提高确诊率.     

肝脏良恶性病变超声造影的对比研究

目的:比较实时谐波超声造影各期相的增强特点,探讨超声造影在肝脏良恶性肿瘤诊断中的临床应用价值.方法:采用实时谐波超声造影技术对37例肝脏肿瘤患者进行检查,并比较不同病变的肝脏超声造影增强特点.结果:恶性病变患者增强开始时间、峰值时间、减退时间、持续时间均早于良性病变患者(P＜0.05),良恶性患者动脉期、门脉期和延迟期病变增强方式也有所不同.结论:超声造影能反映组织血流动力学的改变,对肝脏良恶性病变的诊断及鉴别诊断具有重要的临床应用价值.     

超声造影、增强CT对肝硬化背景下肝内微小结节的诊断价值

目的探讨超声造影、增强CT对肝硬化背景下肝内微小结节的诊断价值。方法选取2017年6月至2019年1月于我院就诊治疗的60例肝硬化患者作为研究对象,所有患者均行超声造影和增强CT检查,比较不同检查方式对肝硬化患者肝内微小结节的检出和诊断符合率,并总结不同影像学检查中的图像表现。结果超声造影检查对肝硬化肝内微小结节的诊断符合率显著高于增强CT检查,尤其对于小肝癌的诊断符合率更高(P<0.05)。超声造影36个肝癌病灶均表现为"快进快出"特征,其中30个病灶在动脉期病灶内表现为造影剂呈球形快速填充,门脉期提前廓清,而在延迟期病灶完全廓清呈低回声改变,6个病灶在动脉期表现为环状向心性快速填充,门脉期至实质期始终同步廓清;而24个增生性结节病灶中有8个在动脉期呈现快速球形填充,在门脉期提前廓清,呈"快进快出"特征;5个肝血管瘤病灶中3个在动脉期表现为向心性增强,门脉期或延迟期缓慢廓清。增强CT检查中,35个肝癌病灶33个在动脉期呈现明显强化,2个未见明显强化,所有病灶均于门脉期和平衡期分别逐渐消退;24个增生性结节病灶在动脉期表现为中度强化,在门脉期呈现高度强化;4个肝血管瘤病灶在动脉期表现为轻度强化,在门脉期持续等强度强化,而延迟期呈现高度强化。结论超声造影对肝硬化患者肝内微小结节病灶诊断符合率显著高于增强CT患者,尤其是对于小肝癌的诊断,超声造影检查诊断更为优势。     

Contrast-enhanced ultrasound of hepatocarcinogenesis in liver cirrhosis

Background Hepatocellular carcinoma often occurs in association with liver cirrhosis. A stepwise carcinogenesis for Hepatocellular carcinoma has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast enhanced ultrasound (CEUS) and to evaluate the value of it in the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard. Methods Ninety-three patients with cirrhosis and indeterminate hepatocellular nodules at CEUS, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules, dysplastic nodules, or dysplastic nodules with focus of hepatocellular carcinoma, were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns (Type I, isoenhancment to hepatic parenchyma at all phases; Type II, hypoenhancment in the arterial phase, and isoenhancment in the portal venous phase and late phase; Type III, iso-to-hypoenhancment in arterial and portal venous phase, and hypoenhancement in the late phase (washout), Type IV, slight hyperenhancment in the arterial and portal venous phase and hypoenhancment in the late phase (washout), and Type V, partial hyperenhancment in the arterial phase and hypoenhancment in the late phase; and another partial iso-to-hypoenhancment in the arterial and portal venous phase and hypoenhancement in the late phase (washout). The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed. Results There were 5 types of enhancement patterns observed in the 132 lesions on CEUS. Type I, 49 (37.1%) nodules demonstrated simultaneous enhancement with the liver parenchyma and, therefore, the nodules appeared isoechoic to the liver throughout the arterial, portal and late phases; Type II, 27 (20.5%) nodules demonstrated delayed enhancement in the portal phase and then became isoechoic to the liver in the late phase; Type III, 28 (21.2%) nodules presented delayed or simultaneous enhancement with the liver and then slight wash-out causing a hypoechoic appearance in the late phase; Type IV, 9 (6.8%) nodules presented slight enhancement with hyperechoic during arterial phase and slight wash-out with hypoechoic to the liver during the late phase. Type V, 19 (14.4%) nodules presented partly enhancement during arterial or portal phase and wash-out during the late phase; the other area of the nodules presented delayed or simultaneous enhancement during arterial phase and slight wash-out in the late phase. There are lighter to heavier grade changes of hepatocellular dysplasia from Type I, Type II, Type III, to Type IV (P<0.05). The pathological diagnosis was hepatocellular carcinoma in the enhanced area and hepatocytes regeneration in the un-enhanced area in the 19 dysplastic nodule with hepatocellular carcinoma. Conclusions CEUS was able to provide reliable evidence for the diagnosis of hepatocellular nodules in liver cirrhosis, and is helpful in predicting the progress from RN to hepatocellular carcinoma nodules by analyzing the hemodynamics and the degree of dysplasia.     

超声造影在肝脏局灶性病变定性诊断中的应用

目的探讨超声造影技术对肝脏局灶性病变（FLL）的定性诊断价值。方法采用造影剂SonoVue和实时超声造影匹配成像技术,对86例FLL行超声造影检查,并分析其造影增强表现。结果恶性FLL开始增强时间（12.5±2.2）S明显比良性FLL（15.4±2.8）S早（P〈0.05）。54个（96.4%）恶性病灶动脉期呈现不同程度的增强,至延迟期消退为低增强,而27个（90.0%）良性病灶则为动脉期增强后,延迟期持续高或等增强。以延迟期消退呈低增强判定为恶性病变,则本组超声造影诊断恶性FLL的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为96.4%（54/56）、90.0%（27/30）、94.7%（54/57）、93.1%（27/29）、94.2%（81/86）。结论超声造影对提高FLL的定性诊断具有实用价值。     

超声造影在肝脏局灶性病变中的应用研究

目的探讨肝脏局灶性病变超声造影增强模式特征及其在鉴别诊断中的意义。方法86例肝脏局灶性病变患者行超声造影检查,记录病灶始增时间及始退时间,并观察分析病灶增强方式。结果良恶性病变的始增时间均可小于30秒;始退时间小于90秒全部为恶性病灶,大于180秒消退者主要是良性病变。恶性病变组与良性组始增时间及消退时间比较均有显著性差异。原发性肝癌主要呈整体均匀增强或不均匀增强;肝转移癌呈周边环状增强或整体增强;肝血管瘤主要呈周边节结状增强;FNH主要呈自中央轮辐状增强。结论超声造影可清晰显示肝脏局灶性病变动态灌注过程,提高肝脏局灶性病变鉴别诊断水平。     

实时超声造影成像诊断肝局灶性结节增生

目的 应用实时低机械指数超声造影成像评价肝局灶性结节增生的血流灌注特征.方法 选择25例肝局灶性结节增生作为研究对象,全部病例经手术、穿刺活检或增强MRI证实.结果 动脉相100％高增强,早期动脉相72％见从中心至周边“星形”或“轮辐样”动脉强化,16％从中心向周边强化范围逐渐扩大,周边出现一过性未强化带,12％未观察到上述特征性征象;门脉相100％高增强;延迟相84％等或略高增强,16％中心部造影剂退出呈低增强.44％可检出三相均不强化的“瘢痕组织”.结论 肝局灶性结节增生超声造影“星形”动脉供血、离心性填充并持续至门脉相是其特征性表现,超声造影表现不典型者需与肝腺瘤、高分化肝细胞癌等高血供病变相鉴别.     

肝局灶性病变超声造影增强时间及模式的临床意义

目的探讨肝局灶性病变（FLL）超声造影增强时间及模式的临床意义。方法对121例FLL进行超声造影检查,将其超声表现进行整理与归纳,分析其造影增强时间（开始时间、峰值时间、消退时间）及增强模式。结果121例FLL患者中,肝细胞性肝癌（HCC）表现为“快进快出”,整体增强者82.5%（52/63）,大部分增强11.1%（7/63）,消退缓慢6.3%（4/63）;肝血管瘤表现为向心性增强85.7%（18/21）,快速增强14.3%（3/21,瘤体直径≤20mm）;转移性肿瘤（MLC）呈快速环形边周增强,快速消退72.7%（8/11）,瘤体始终不增强27.3%（3/11）;局灶性结节性增生（FNH）表现为中央至整个瘤体的增强75.0%（3/4）;肝脓肿和肝内胆管癌全部表现为环形增强;肝硬化增生结节和局灶性脂肪肝均表现为与肝组织同时增强及消退,且强度一致。结论超声造影增强时间及模式与肿瘤的血供特点关系密切,超声造影对肝局灶性病变的定性诊断有较大的临床意义。     

Contrast-enhanced ultrasound of hepatocarcinogenesis in liver cirrhosis

Background  Hepatocellular carcinoma (HCC) often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast-enhanced ultrasound (CEUS) and to correlate patterns of enhancement at CEUS with the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard.

Methods  Ninety-three cirrhotic patients with indeterminate hepatocellular nodules at ultrasound, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules (RNs), dysplastic nodules (DNs), or DNs with focus of HCC (DN-HCC), were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns: type I, isoenhancement to hepatic parenchyma at all phases; type II, hypoenhancement in the arterial phase, and isoenhancement in the portal venous phase and late phase; type III, iso-to-hypoenhancement in arterial and portal venous phase, and hypoenhancement in the late phase (washout); type IV, slight hyperenhancement in the arterial and portal venous phase and hypoenhancement in the late phase (washout); and type V, partial hyperenhancement in the arterial phase and hypoenhancement in the late phase; and another partial iso-to-hypoenhancement in the arterial and portal venous phase and hypoenhancement in the late phase (washout). The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed by the chi-squared test.

Results  Totally 132 lesions were examined with CEUS in 93 patients. Pathologic diagnoses included 45 DN, 68 RN, and 19 DN-HCC. The enhancement patterns observed were as follows: type I, 49 (37.1%); type II, 27 (20.5%); type III, 28 (21.2%); type IV, 9 (6.8%); type V, 19 (14.4%). Nodules with type I enhancement showed dysplasia in 5 (10.2%) cases; nodules with type II were dysplastic in 11 (40.7%) of cases; nodules with type III enhancement pattern were dysplastic in 22 (78.6%), and those with type IV enhancement contained dysplasia in 7 (77.8%) of cases. Type V enhancement corresponded to DN-HCC in 19 (100%) of cases. CEUS enhancement pattern was correlated with likelihood of dysplasia at pathologic analysis (Trend chi-square test, P <0.001). Pathological diagnosis was HCC in the enhanced area and hepatocyte dysplasia in the un-enhanced area in the 19 DN-HCC.

Conclusion  Pattern of enhancement at CEUS correlates with the pathologic diagnosis of hepatocellular nodules in liver cirrhosis, and may be helpful in predicting the progress from RN to HCC nodules.     

常规超声检查难以定性的复杂盆腔包块超声造影增强特点

 摘要：【目的】探讨常规超声检查难以定性的盆腔肿块超声造影增强特点。【方法】对常规超声检查难以定性的137例盆腔肿块进行超声造影检查。分析病灶增强开始时间、增强水平、形态和增强模式的特点。【结果】良恶性病灶超声造影表现各不相同。增强时间早于子宫肌层呈高增强的恶性、良性病灶分别为85.3%（29/34）和13.7%（14/103）;增强形态不均匀的恶性、良性病灶分别为 97.1%（33/34）和31.0 % (32/103);增强模式I型的恶性、良性病灶分别为85.3%（29/34）和9.7%（10/103）,上述两组结果比较,差异均有统计学意义(p＜0.01)。【结论】复杂的盆腔良恶性肿块造影增强模式具有特征性,可为病变的定性诊断提供信息。     

超声造影与彩色多普勒诊断肝肿瘤的临床应用

目的比较实时超声造影和彩色多普勒超声在肝肿瘤诊断中的临床应用价值。方法应用超声造影技术及彩色多普勒超声对常规二维超声难以定性的30例患者31个肝占位灶进行检查,并与病理结果相对照。结果31个病灶中肝恶性肿瘤24个,肝血管瘤3个,肝硬化增生结节1个,肝脓肿2个,肝包虫1个。除1例肝包虫外,其余30个病灶超声造影均在不同时相出现不同程度强化现象。彩色多普勒超声在病灶内部或周边能检测到动脉血流频谱者共19例20个病灶;以增强早期呈高回声而增强晚期呈低回声为恶性肿块的诊断标准,则超声造影对肝癌诊断的准确性为93％;以病灶内部检测到动脉样血流频谱为诊断恶性肿块的诊断标准,则彩色多普勒超声诊断肝恶性肿瘤的准确性为74％,二者差别有统计学意义（P〈0．05）。结论实时超声造影能提高肝肿瘤诊断的准确性,对肝肿瘤良、恶性的诊断及鉴别诊断具有重要的临床应用价值。     

SonoVue超声造影在肝硬化局灶性小病变中的诊断价值

目的探讨新型造影剂SonoVue对肝硬化背景下肝局灶性小病变的诊断价值。方法采用造影剂SonoVue和对比脉冲序列(CPS)技术,对43例肝硬化背景下可疑肝局灶性病变48个病灶病变行超声造影检查。38例经手术或穿刺病理,5例经CT、MRI增强检查和临床综合资料证实病灶性质。结果恶性病灶组和良性病灶组达峰时间、始消时间和持续时间比较,差异有统计学意义(P0.05)。21例肝细胞癌21个病灶和3例转移性肝癌4个病灶表现为在动脉相均匀增强;2例肝胆管细胞癌2个病灶和2例转移性肝癌3个病灶,表现为动脉相不均匀增强且以周边增强为主;1例肝细胞癌1个病灶在所有时相均呈等增强。肝血管瘤7例9个病灶,表现为动脉相以周边结节状增强,门脉期及延迟期病灶增强范围呈向心性扩散。3例局灶性结节增生3个病灶呈轮辐状从病灶中央向周边增强。4例肝硬化结节5个病灶在3个时相均呈等增强。本组超声造影诊断正确率为97.68%,假阴性率为3.45%。结论超声造影对肝硬化背景下局灶性小病变的良恶性鉴别有重要的诊断价值。