Contrast‐Enhanced Ultrasonography in Patients With Glycogen Storage Disease Type Ia and Adenomas

Objective. The purpose of this series was to evaluate the value of contrast‐enhanced ultrasonography (CEUS) in the characterization of focal liver lesions (FLLs) in patients with glycogen storage diseases (GSDs). Methods. Contrast‐enhanced ultrasonographic data obtained for characterization of 8 FLLs (size, 0.9–10.2 cm) in 2 patients with GSD type Ia (GSD‐Ia) and lesion growth or recurrent abdominal pain were reviewed and compared with computed tomographic (CT) and magnetic resonance imaging (MRI) data. After total and left hepatectomy, pathologic examination confirmed benign adenomas in 6 of the evaluated lesions. Follow‐up confirmed benignity in the 2 remaining lesions. Results. In all FLLs, CEUS showed marked hypervascularity in the early arterial phase. Centripetal filling was shown in only 1 lesion, and diffuse enhancement without any clear direction was shown in all other lesions. During the portal and late phases, 6 of the 8 lesions showed sustained enhancement, including 2 lesions that appeared heterogeneous during all phases of CT and MRI. In an aspect of 1 of these 6 large adenomas, late wash‐out could be explained by sinusoid compression. The other 2 adenomas showed moderate wash‐out but remained homogeneous. Conclusions. Focal liver lesions found in patients with GSD‐Ia have similar patterns on CEUS compared with incidental adenomas. Global or partial hypoenhancement observed in the late phase did not indicate a transition to hepatocellular carcinoma but may have been related to ischemia.     

Value of Contrast‐Enhanced Ultrasonography in Assessing the Vascularity of Liver Metastases

Objective. The purpose of this study was to compare the capability of contrast‐enhanced ultrasonog‐raphy (CEUS) and contrast‐enhanced computed tomography (CECT) in evaluating the vascularity of liver metastases. Methods. Both CEUS and CECT examinations were performed on 70 patients with liver metastases, which were from colon carcinoma in 31, rectal carcinoma in 17, pancreatic carcinoma in 5, and others in 17. In patients with multiple lesions, the most easily observed lesion was selected as the target lesion for evaluation of vascularity. Results. Peak enhancement of the target lesion during the arterial phase was characterized as hyperenhancement, isoenhancement, hypo‐enhancement, and nonenhancement in 61 (87.1%), 6 (8.6%), 3 (4.3%), and 0 (0%) patients on CEUS, respectively, and in 52 (74.3%), 8 (11.4%), 8 (11.4%), and 2 (2.9%) on CECT. Contrast‐enhanced ultrasonography showed more lesions with hyperenhancement than CECT (P < .01). The enhancement pattern during the arterial phase was homogeneous, inhomogeneous, and rimlike in 30 (42.9%), 16 (22.9%), and 24 (34.2%) patients on CEUS and in 13 (18.6%), 8 (11.4%), and 49 (70%) on CECT. Contrast‐enhanced ultrasonography revealed more lesions with homogeneous enhancement than CECT (P < .01). Contrast‐enhanced ultrasonography showed dysmorphic vessels in 33 patients (47.1%) during the arterial phase, whereas CECT showed dysmorphic vessels in 27 (38.6%; P < .01). Contrast‐enhanced ultrasonography showed hypervascular lesions in 58.6% of patients, whereas CECT showed hypervascular lesions in 12.9% (P < .01). Conclusions. Contrast‐enhanced ultrasonography was superior to CECT in assessing the vascularity of liver metastases.     

超声造影在肝脏局灶性病变定性诊断中的应用研究

目的探讨不同性质之肝脏局灶性病变（FLLs）的超声造影（CEUS）特征表现。方法对60例肝脏局灶性病变患者进行超声造影检查,并与增强CT、病理结果进行对照。结果超声造影后各种FLLs显示不同的造影特点。CEUS定性诊断率与增强CT对照差别无统计学意义。结论CEUS能显示局灶性病变内微小血管的血流灌注情况,对FLLs的定性诊断具有重要的意义。     

超声造影诊断肝局灶性病变在县市级医院的应用

目的探讨超声造影对肝脏局灶性病变的诊断价值以及超声造影技术在县市级医院的可行性。方法125例常规超声检查不能完全明确诊断的肝脏局灶性病变患者,采用造影剂SonoVue进行超声造影。分析研究不同性质的肝脏局灶性病变在不同时相的增强表现。结果不同性质的肝脏局灶性病变都有其特征性的增强模式．从而有助于鉴别诊断。与增强CT或增强MRI对照,大多数病灶有相似的增强变化规律。超声造影的诊断准确率达到94．4％（118／125）。结论超声造影技术可明显提高对肝脏局灶性病变的诊断水平,而且在县市级医院开展此技术是可行的。     

Can contrast-enhanced ultrasonography characterize focal liver lesions and differentiate between benign and malignant,thus providing a one-stop imaging service for patients?

Purpose

Contrast-enhanced ultrasonography (CEUS) displays high sensitivity and specificity in characterizing focal liver lesions (FLLs). We attempted to determine how often CEUS provides an unequivocal diagnosis of FLLs that does not require additional imaging studies.

Materials and methods

Seventy-three patients with 146 FLLs were scanned with B-mode, Doppler, and contrast-enhanced US (2 × 2.4 ml SonoVue, low MI, 4–6 MHz curved array transducer, Toshiba Aplio/Siemens–Acuson Sequoia). Data were digitally stored and transferred to a work station with the GE PACS system. Images were reviewed by a consultant radiologist experienced in CEUS and interpreted in accordance with the criteria for characterizing FLLs published by the European Federation of Societies for Ultrasound in Medicine and Biology. Diagnoses were compared with those based on computed tomography (CT) and/or magnetic resonance (MR) findings if these were available. However, our aim was to assess the frequency with which CEUS provided diagnoses that were considered reliable enough to exclude the need for other imaging studies. Therefore, the CEUS diagnoses were not necessarily confirmed by other methods.

Results

Based on CEUS findings alone, 130/146 (89.0%) FLLs could be classified as benign or malignant, and in 118/146 (80.8%) cases, the lesion could be specifically identified. The other 28/146 (19.2%) FLLs could not be characterized based on CEUS data alone. In 58 (80.8%) of the 73 patients with multiple FLLs, CEUS findings were sufficient to establish the benign vs. malignant nature of all the patient''s lesions; in 51/73 (69.9%) patients, all the lesions could also be characterized with CEUS. In the remaining cases, at least one lesion required additional imaging to determine whether it was malignant (14/73, 19.2%) or to establish its identity (22/73, 30.1%). In 4/73 (5.5%) patients, CEUS revealed additional lesions not detected on B-mode US.

Conclusions

CEUS alone was sufficient to classify 89.0% of the FLLs as benign or malignant, and in 80.8% it was also regarded as sufficient to identify the lesion. It served as a one-stop diagnostic test for 80.8% of the patients, reducing the need for CT–MR scans and providing savings in terms of radiation exposure, time, and money.keywords: Ultrasound, Contrast agents, Focal liver lesions, Cost benefit     

肝局灶性病变超声造影的误诊病例分析

目的 探讨肝局灶性病变超声造影的误诊因为.方法 收集有病理诊断的578例肝局灶性病变的超声造影资料,将其中与病理诊断不符的75例进行回顾性分析.结果 29例肝良性病变被超声造影误诊为肝癌,占误诊的38.7%.20例肝癌被超声造影误诊为肝良性病变,占误诊的26.7%.13例肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)被误诊为肝细胞癌(hepatocellular carcinoma,HCC).4例HCC被误诊为ICC.1例胆道乳头状黏液腺癌、1例肝转移癌和1例神经内分泌癌被误诊为HCC,1例HCC和1例ICC被误诊为肝转移癌.3例肝增生病变和1例炎性假瘤被误诊为肝血管瘤.原发性肝癌与肝内增生病变的混淆诊断占误诊的首位,炎性病变与恶性肿瘤的混淆诊断居次位.结论 不同病变的增强模式相似是超声造影出现误诊的原因,分析造影图像细节,紧密结合临床,可提高超声造影的诊断准确率.     

超声造影技术在肝脏局灶性病变诊断中的应用

目的 探讨实时谐波超声造影在肝脏局灶性病变诊断中的应用价值.方法 采用实时谐波超声造影技术对31例肝脏局灶性病变进行检查,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.     

Clinical Application of Contrast‐Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Objective. The purpose of this study was to evaluate the value of contrast‐enhanced ultrasonography (CEUS) in differential diagnosis of superficial lymphadenopathy. Methods. Ninety‐four superficial enlarged lymph nodes in 94 patients were studied by conventional ultrasonography (gray scale and color Doppler) and CEUS. Contrast‐enhanced sonograms were analyzed using contrast‐specific quantification software. All of the results were compared with pathologic diagnoses. Results. Of the 94 lymph nodes examined, 44 were benign and 50 were malignant (33 metastases and 17 lymphomas). The sensitivity, specificity, and accuracy of conventional ultrasonography in differential diagnosis between benign and malignant nodes were 51%, 47%, and 55%, respectively. Contrast‐enhanced ultrasonography showed intense homogeneous enhancement in 39 of 44 benign lymph nodes, inhomogeneous enhancement in 32 of 33 metastases, and intense homogeneous enhancement and absence of perfusion in 9 of 17 and 6 of 17 lymphomas, respectively. The sensitivity specificity, and accuracy of CEUS were 84%, 79%, and 80%. After time‐intensity curve gamma variates were calculated, the area under the curve of the benign lymph nodes was greater than those of the metastatic lymph nodes and lymphomas (P < .01). Conclusions. These results indicate that the use of CEUS and contrast‐specific software has a higher degree of diagnostic accuracy than conventional ultrasonography for evaluations of superficial lymphadenopathy. The contrast enhancement patterns and time‐intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant lymph nodes.     

Hypoechoic focal liver lesions: characterization with contrast enhanced ultrasonography

PURPOSE: To evaluate the late sinusoidal phase of contrast enhancement with a 2nd-generation ultrasound contrast enhanced medium in the characterization of hypoechoic focal liver lesions. METHODS: We studied 88 hypoechoic liver lesions (diameter range, 1-18 cm; with 18 lesions 2 cm or less) found on conventional grayscale sonography (US) with contrast-enhanced ultrasonography (CEUS). Final diagnosis was made using contrast enhanced helical CT, contrast enhanced MR, angiography (DSA), and/or histopathic confirmation or clinical imaging follow-up. RESULTS: There were 37/88 benign lesions demonstrated: 17 cavernous hemangiomas, 3 capillary hemangiomas, 11 focal nodular hyperplasias (FNH), 3 focal areas of sparing in hepatic steatosis, 2 adenomas, and 1 intrahepatic necrotic area. Malignant lesions demonstrated included 51/88: 27 hepatocellular carcinomas (HCC) in cirrhosis, 11 metastatic carcinomas, 10 metastatic endocrine tumors, 2 cholangiocellular carcinomas (CCC) and 1 non-Hodgkin's lymphoma (NHL). CEUS characterized 30/37 (81%) benign lesions and 45/51 (88%) malignant lesions. On the basis of the results obtained during the sinusoidal contrast enhanced phase of CEUS, diagnosis of benignancy was possible in 35/37 (95%) of benign liver lesions and diagnosis of malignancy in 49/51 (96%) of malignant liver lesions. The enhancement pattern of 13 small (< or = 2 cm in diameter) hypervascular liver lesions (3 capillary hemangiomas, 2 FNHs, 4 HCCs, 4 metastatic endocrine tumors) was better demonstrated on CEUS than on helical CT. In these cases the hyper vascularization of the lesions shown on CEUS was not confirmed on CT. CONCLUSIONS: CEUS distinguished malignant from benign hypoechoic liver lesions with an accuracy of 95%.     

Renal Cell Carcinoma and Renal Angiomyolipoma

Objective. The purpose of this study was to evaluate the usefulness of contrast‐enhanced ultrasonography (CEUS) in differentiating renal cell carcinoma (RCC) from renal angiomyolipoma (RAML). Methods. One hundred nineteen patients with 126 renal lesions (33 RAMLs and 93 RCCs) who had undergone CEUS were retrospectively studied. All of the lesions were histopathologically or clinical proved. Contrast‐enhanced ultrasonography was performed using low–acoustic power modes and a sulfur hexafluoride–filled microbubble contrast agent. The baseline sonograms and CEUS images were retrospectively analyzed in consensus by 2 radiologists. The tumor echogenicity, enhancement patterns, and degree of enhancement at different phases were evaluated. The diagnostic efficacy of CEUS in differentiating the two diseases was computed and compared. Results. On CEUS, the features of wash‐out from hyperenhancement or isoenhancement to hypoenhancement over time (observed in 3.0% of RAMLs and 71.0% of RCCs; P < .001), heterogeneous enhancement (observed in 12.1% of RAMLs and 74.2% of RCCs; P < .001), and an enhanced perilesional rim (observed in 3.0% of RAMLs and 79.6% of RCCs; P < .001) achieved significant difference between RCCs and RAMLs. Early wash‐out and heterogeneous enhancement or peritumoral rim enhancement yielded the highest diagnostic capability in differentiating RCC from RAML. The corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88.2% (82 of 93), 97.0% (32 of 33), 98.8% (82 of 83), 74.4% (32 of 43), and 90.5% (114 of 126), respectively. Conclusions. The CEUS features of early wash‐out, heterogeneous enhancement, and an enhanced peritumoral rim highly suggest RCC, whereas homogeneous enhancement and prolonged enhancement are characteristic manifestations of RAML. Contrast‐enhanced ultrasonography is valuable in differentiating RCC from RAML.     

Multiparametric Sonography of Hematologic Malignancies of the Testis: Grayscale,Color Doppler,and Contrast‐Enhanced Ultrasound and Strain Elastographic Appearances With Histologic Correlation

Primary testicular lymphoma is rare and appears with nonspecific findings on grayscale and color Doppler sonography. We present 8 patients further examined with contrast‐enhanced sonography, strain elastography, and histologic analysis after orchiectomy. Seven of 8 patients had a diagnosis of large B‐cell lymphoma, and 1 of 8 had a diagnosis of granulocytic sarcoma, with solitary lesions (2 of 8), multiple lesions (3 of 8), or entire testicular involvement (3 of 8). Lesions appeared hypoechoic (7 of 8) or isoechoic (1 of 8), all with increased vascularity on color Doppler sonography and a nonbranching linear pattern of intratumoral vessels (7 of 8). Contrast‐enhanced ultrasound (CEUS) confirmed this pattern and showed increased enhancement in all lesions. On strain elastography, all lesions were hard, with an elasticity score of greater than 4. Multiparametric sonography of testicular lymphoma identifies increased vascularity on color Doppler and contrast‐enhanced ultrasound and increased lesion stiffness on strain elastography.     

Focal Hypoechoic Tumors of Fatty Liver

Objective. The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast‐enhanced ultrasonography (CEUS). Methods. Sixty‐four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results . Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill‐in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS. Conclusions. With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved.     

The Nodular Form of Hepatic Tuberculosis

Objective. The purposes of this study were to describe the ultrasonographic findings in hepatic tuberculosis (TB) after administration of a second‐generation sulfur hexafluoride–filled microbubble contrast agent and to correlate these findings with pathologic characteristics. Methods. Twenty‐four hepatic TB lesions in 15 patients were studied with conventional ultrasonography (CUS) and contrast‐enhanced ultrasonography (CEUS). Pathologic characteristics of the lesions were evaluated and were then correlated with enhancement patterns. Results. The appearance of hepatic TB on CUS was variable and nonspecific with respect to the shape, echogenicity, and boundary of the lesions. The diameters of the lesions obtained from CEUS were statistically larger than those from CUS, with largest diameters ± SD of 4.2 ± 1.8 and 3.1 ± 1.9 cm, respectively. During the arterial phase, 13 of 24 lesions (54.2%) showed a rapidly and markedly enhanced rim with a hypoenhanced or nonenhanced center; 9 of 24 lesions (37.5%) showed transient enhancement of the whole lesion with inconsistent intensities. During the portal phase, most lesions showed distinct wash‐out of the contrast agent and maintained a hypoechoic appearance. Pathologic studies confirmed that the different appearances of hepatic TB on CEUS were related to the different pathologic stages of the lesions. Conclusions. Findings of hepatic TB on CEUS may be helpful in differentiating the diagnosis from other hepatic focal lesions. Correlation with pathologic findings would enrich the understanding of CEUS findings in hepatic TB.     

超声造影技术在肝脏恶性占位术前检查中的应用

目的 通过对比灰阶超声和超声造影(CEUS)对肝脏良恶性肿瘤大小的测值,探讨超声造影技术在肝脏恶性肿瘤术前检查中的应用价值。方法 肝脏占位患者60例,共60个病灶,分别采用灰阶超声和CEUS,对比不同方式的超声检查所观察到的肿瘤形态、大小,分析CEUS在肝脏良恶性病变治疗提供检测信息的准确性及其机制。结果 60例患者中,29例高回声病灶均为肝血管瘤,27例低回声病灶(22例为原发性肝细胞癌,5例为血管瘤),4例混合回声为原发性肝细胞癌。CEUS的动脉相,静脉相,延迟相同普通灰阶超声测量血管瘤的大小相比较,差异不显著(P>0.05);CEUS的动脉相原发性肝细胞癌的大小测值较其它超声检测方法更大,组间差异显著(P<0.05)。 结论 CEUS能够为原发性肝细胞癌治疗手术方案的选择和制定,手术切除范围的确定提供准确而有价值的参考。     

原发性肝淋巴瘤的诊断(附7例报告)

目的 探讨原发性肝淋巴瘤(PHL)的诊断方法。方法 回顾性分析7例手术病理诊断为原发性肝淋巴瘤患者的临床特点和超声等影像学表现。结果 PHL的主要临床表现为肝区胀痛或上腹不适(4例)，肝肿大(3例)；血清乙肝二对半阳性者5例，曾患肝炎5例，其中慢性肝炎或肝硬化4例；均无发热及外周淋巴结肿大；超声声像图除1例外均表现为低回声病灶，CT表现为低密度占位，二维超声和彩色多普勒超声共误诊为良性病变1例次、血管瘤4例次，误诊率为62．5％(5／8)；CT误诊为血管瘤或炎症性病变3例次，误诊率50％(3/6)；MRI误诊为血管瘤1次，误诊率50％(1/2)。结论 原发性肝淋巴瘤临床及超声等影像学表现无特异性，确定诊断必须依靠组织学检查及免疫组织化学测定。在声像图上表现为非常见的原发性肝癌及肝血管瘤等典型声像图或图像类似肝转移性肿瘤但无原发肿瘤存在时，应注意与之鉴别。     

Comparison of Contrast-Enhanced Ultrasound versus Contrast-Enhanced Magnetic Resonance Imaging for the Diagnosis of Focal Liver Lesions Using the Liver Imaging Reporting and Data System

The aim of this retrospective study was to evaluate the Liver Imaging Reporting and Data System (LI-RADS) categorization of focal liver lesions (FLLs) on contrast-enhanced ultrasound (CEUS) in comparison with contrast-enhanced magnetic resonance imaging (CE-MRI). A total of 63 patients with 84 FLLs were included in the final study population, after review of the electronic medical records and clinical data. Two trained radiologists evaluated all CEUS and CE-MRI images independently. They assigned a LI-RADS category to each FLL and assessed major features based on CEUS LI-RADS Version 2017 and computed tomography/MRI LI-RADS Version 2018. The generalized estimating equation method was used to compare the diagnostic performance of the LI-RADS algorithm between CEUS and CE-MRI. The sensitivity of LR-5/LR-TIV (tumor in vein) categories for diagnosing hepatocellular carcinoma (HCC) differed significantly between CEUS and CE-MRI (88.9% [40/45], 95% confidence interval [CI]: 76.5%–95.2%), versus 64.4% (29/45; 95% CI: 49.8%–76.8%), p = 0.006; 82.2% (37/45; 95% CI: 68.7%–90.7%), versus 62.2% (28/45; 95% CI: 47.6%–74.9%), p = 0.034. Inter-observer agreement was substantial for assigning LR-5 on both CEUS and CE-MRI. For both reviewers, there was a higher frequency of LR-5 (44.0% vs. 25.0%, p = 0.009; 42.9% vs. 26.2%, p = 0.023) in CEUS compared with CE-MRI. Arterial phase hyper-enhancement (APHE) was less frequently observed on CEUS than on CE-MRI (46.4% vs. 61.9%, p = 0.044). However, the washout appearance was observed more frequently on CEUS than on CE-MRI (50.0% vs. 28.6%, p = 0.004). Inter-observer agreement between the two reviewers on APHE and washout appearance was excellent for both CEUS and CE-MRI. These findings suggest that CEUS had a much higher sensitivity than CE-MRI in the diagnosis of HCC using LI-RADS, and although the frequencies of major features differed, inter-observer agreement between the two reviewers on major features of HCC was excellent for both CEUS and CE-MRI.     

超声造影动脉期增强模式对肝脏局灶性病变的诊断价值

目的探讨超声造影动脉期增强模式对肝脏局灶性病变的诊断价值。方法对81个肝脏局灶性病变进行超声造影检查,对其中25例病灶行微血管显像（MFI）,分析超声造影动脉期增强模式的诊断价值以及MFI显像技术对于增强模式判断的帮助。结果超声造影向心性增强对肝血管瘤诊断的敏感性85.7%、特异性100%、阳性预测值100%、阴性预测值98.7%、准确性98.8%;环状增强对于肝转移瘤诊断的敏感性80.0%、特异性98.2%、阳性预测值95.2%、阴性预测值91.7%、准确性92.6%;超声造影动脉期离心性增强在肝细胞肝癌也可见到,25例病灶使用MFI后对其中14例（14/25,56.0%）动脉期增强模式的判断有帮助,对离心性增强模式及向心性增强模式的判断帮助尤为明显。结论超声造影动脉期向心性增强及环状增强分别对于肝血管瘤及肝转移瘤有很好的诊断价值,离心性增强可见于肝细胞肝癌,MFI技术的应用对于增强模式的判断有帮助。     

Liver tumor characterization--comments and illustrations regarding guidelines

Contrast-enhanced ultrasound (CEUS) is a well established diagnostic imaging technique for a variety of indications and applications. One of the most important applications is in the liver where it is frequently a first-line technique for the detection and diagnosis (characterization) of focal liver lesions (FLLs). In this setting the accurate differentiation of benign lesions from malignant lesions is critical to ensure that the patient undergoes the appropriate therapeutic option. In this article the role of CEUS in the characterization of FLLs is described on the basis of recently published guidelines, in particular in terms of the enhancement patterns of the most common FLLs, e. g. hemangioma, focal nodular hyperplasia, hepatocellular adenoma and their differentiation from malignant lesions.     

超声造影对Budd-Chiari综合征合并肝脏局灶性结节的鉴别诊断价值

目的 探讨Budd-Chiari综合征(BCS)合并肝脏局灶性结节的超声造影鉴别诊断要点.方法 回顾性分析36例BCS合并肝局灶性结节患者的常规超声及超声造影图像,并结合临床病理检查和增强CT及MRI成像等其他影像学检查资料分析.结果 36例BCS患者中11例合并肝癌结节,25例合并增生结节.其中BCS合并肝癌结节超声造影模式为典型的"快进快出",BCS合并增生结节的超声造影表现是多样化的,可分为3型.Ⅰ型增生结节超声造影3个时相与周围肝实质相比均呈等增强;Ⅱ型和Ⅲ型虽然造影特点不同,Ⅱ型动脉相呈离心性增强,Ⅲ型动脉相呈环状向心性增强,但延迟相均较周围肝实质呈等增强或部分高增强.结论 BCS合并肝脏局灶性结节超声造影表现呈多样化,超声造影对鉴别结节良恶性有重要价值.     

Present status of hepatitis virus-associated hepatocellular carcinoma in Nagasaki Prefecture, Japan: a cross-sectional study of 1019 patients

The present study was designed to determine the frequency of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients with hepatocellular carcinoma (HCC) in Nagasaki Prefecture, Japan. We examined the clinical features of 1019 patients with HCC who visited our hospitals between January and December 1999. The ratio of men to women was 709 : 310, and the peak incidence of HCC was in the seventh decade of life in both men and women. In the majority of the patients, HCC showed association with HCV infection (74%) compared with HBV infection (17%). HBV-associated HCC was more common in young patients, while HCV-associated HCC was more common in patients with a history as a "daily drinker", or with a history of blood transfusion, liver cirrhosis, and persistently high serum transaminases before the diagnosis of HCC. HCC was initially suspected by ultrasonography or computed tomography in 776 of the 874 patients for whom there was a history of mode of detection of HCC (89%). Tumor size at the time of diagnosis of HCC in patients who had been regularly followed up for liver diseases at our hospitals was significantly smaller than that in patients who were not followed up regularly before the diagnosis (P < 0.01). Our results indicate that the proportions of patients with HBV or with HCV infection among HCC patients in Nagasaki Prefecture are similar to those found in a nationwide survey in Japan, and there are some differences between the clinical manifestations of HBV- and HCV-associated HCC. Our results emphasize the importance of close follow-up for the high-risk group (i.e. those with HBV- or HCV-associated chronic liver diseases) for the early detection of HCC. Received: July 18, 2001 / Accepted: September 17, 2001