超声造影对肝转移癌的诊断价值

目的观察超声造影对肝转移癌的灌注过程及回声变化规律,探讨超声造影对肝转移癌的诊断应用价值。方法应用超声造影剂SonoVue及CnTI实时灰阶造影匹配成像技术,对53例被确诊患有恶性肿瘤并经超声检查检出或疑有肝占位者行超声造影检查,增强CT检查其中49例发现肝占位。超声造影记录所观察病灶的造影剂灌注过程,转移灶的大小、数目,并与常规超声及增强CT结果进行比较。结果常规超声检查53例发现131个病灶,超声造影确认51例193个病灶,22例发现新病灶62个,其中<1.0cm占41.9%(26灶);CT发现新病灶46个;常规超声、CT、超声造影3种方法显示的最小病灶分别为0.8cm,0.9cm,0.6cm。51例肝转移癌109个重点观察病灶超声造影的灌注特征呈4种形式:第一种为肿瘤周边呈快速环状强化,本组占72.5%(79个灶);第二种为动脉期快速团状强化,快速廓清,占15.6%(17个灶);第三种为动脉期至实质期病灶内均无增强,占8.2%(9个灶);第四种动脉期或门脉期延迟增强或与肝同步,实质后期轻度退出,占3.7%(4个灶)。结论肝转移癌超声造影灌注特征的研究以及对转移癌数目、部位的确认,尤在实质期对小转移灶及临床前期微小癌灶的早期检出,对临床分期诊断及治疗方法的选择提供了重要的依据,有较高的临床应用价值。     

实时超声造影对胃肠道癌同时性肝转移微小病灶的诊断价值

肝是胃肠道肿瘤转移的最常见部位之一,在确诊胃肠道癌同时以及术后的6个月内发现的肝转移,称为胃肠道癌同时性肝转移[1].依据王夕富等[2]的建议将≤1 cm的肝转移癌定义为微小肝转移癌.在胃肠癌术前和术后6个月随访过程中,常规超声不易发现肝的微小病灶,致使一部分患者失去或延误了及时有效的治疗.本研究旨在探讨实时超声造影对胃肠道癌肝转移微小病灶的诊断价值.     

实时超声造影对胃肠道癌同时性肝转移微小病灶的诊断价值

肝是胃肠道肿瘤转移的最常见部位之一,在确诊胃肠道癌同时以及术后的6个月内发现的肝转移,称为胃肠道癌同时性肝转移[1].依据王夕富等[2]的建议将≤1 cm的肝转移癌定义为微小肝转移癌.在胃肠癌术前和术后6个月随访过程中,常规超声不易发现肝的微小病灶,致使一部分患者失去或延误了及时有效的治疗.本研究旨在探讨实时超声造影对胃肠道癌肝转移微小病灶的诊断价值.     

实时超声造影对胃肠道癌同时性肝转移微小病灶的诊断价值

肝是胃肠道肿瘤转移的最常见部位之一,在确诊胃肠道癌同时以及术后的6个月内发现的肝转移,称为胃肠道癌同时性肝转移[1].依据王夕富等[2]的建议将≤1 cm的肝转移癌定义为微小肝转移癌.在胃肠癌术前和术后6个月随访过程中,常规超声不易发现肝的微小病灶,致使一部分患者失去或延误了及时有效的治疗.本研究旨在探讨实时超声造影对胃肠道癌肝转移微小病灶的诊断价值.     

超声造影在肝肿瘤诊断中的应用

目的:探讨超声造影对肝肿瘤的诊断价值.方法:对常规二维超声发现的72例患者共79个肝内病灶行超声造影检查.结果:79个病灶中原发性肝细胞性肝癌59个,肝血管瘤10个,肝转移癌9个,肝孤立性坏死结节1个.超声造影除1例肝孤立性坏死结节外,其余78个病灶均在不同时相出现不同程度及不同方式的强化现象,超声造影对肝癌和肝肿瘤总体的确诊率均为95%.结论:超声造影可显著提高肝肿瘤和病变性质的确诊率.     

超声造影术前诊断结直肠癌肝转移的应用价值

目的 以手术病理组织学结果为金标准,探讨结直肠癌肝转移患者术前超声造影检查的临床应用价值.方法 对42例结直肠癌肝转移患者行肝超声造影检查,造影所见肝内病灶数目、位置、大小与手术病理结果进行对照.结果 42例切除并经病理组织学证实的肝转移癌灶96个,大小0.3～8.5em,平均(2.6±1.8)cm,每例1～8个病灶;其中21个(21.9％)≤1.0 cm.术前超声造影准确检出86个癌灶,敏感性89.6％(86/96个),对≤1.0cm癌灶敏感性71.4％(15/21个);造影门脉期至延迟期检出的35个癌灶中19个(54.3 ％)常规超声未能发现.42例中治愈性手术切除率88.1％(37例),此37例术后随访3～39个月,2年内肝内复发率32.4％(12例),1年生存率90.0％.结论 超声造影对结直肠癌肝转移尤其对小癌灶有较高敏感性,有助于术前准确分期,选择合理治疗方案.超声造影可作为术前无创性影像检查的重要手段之一.     

超声造影在评价肝癌射频消融临床疗效中的作用

目的了解超声造影对肝肿瘤射频消融(RFA)疗效评价的应用价值.方法选取肝细胞肝癌(HCC)患者12例23个病灶、肝转移瘤1例2个病灶为观察对象.全部病灶RFA治疗后即刻至2个月采用超声造影检查评价疗效,并与彩超和增强CT检查结果进行比较.结果RFA治疗后超声造影显示19个消融灶各期均无异常增强区,提示肿瘤完全灭活;4个消融灶边缘局部有早期增强判断有肿瘤残存;2个可疑残存肿瘤.经CT、穿刺活检及12个月以上随访,证实超声造影正确诊断23个病灶(23/25),与增强CT检查结果相近.超声造影发现新生病灶23个,其中2例有9个直径为＜1 cm的病灶,同期CT未能显示.结论超声造影是评价RFA疗效的一种有效方法,且能明确肿瘤残存部位引导补充治疗,并有助于发现微小新生病灶.     

肝脏局灶性病变的超声造影误诊分析

目的探讨肝脏局灶性病变的超声造影误诊原因,提高其诊断价值。方法回顾性分析8例超声造影误诊为肝细胞肝癌的肝脏局灶性病变患者的声像图特征,并分析其误诊原因。结果误诊的8例患者中,病理结果提示肝脏局灶性结节增生、肝内胆管细胞癌及血管瘤各2例,炎性假瘤和不典型结节增生各1例。所有误诊病灶超声造影均表现为动脉相呈高或等增强,门脉相或延迟相减退为低增强。结论不同病理类型的病灶具有相似的增强模式是超声造影误诊的原因,仔细观察超声造影图像特征,紧密结合临床检查结果,必要时行穿刺活检,可提高超声造影对肝脏局灶性病变诊断的准确率。     

实时超声造影与增强螺旋CT检出恶性肿瘤肝转移灶的临床研究

目的 比较常规超声、超声造影及增强CT对恶性肿瘤肝转移灶的检出能力。方法 应用超声造影剂SonoVue及反向脉冲谐波造影成像技术,对73例已确诊为恶性肿瘤并疑有肝转移的患者进行超声造影检查,与常规超声及增强CT结果进行比较。结果 常规超声在67例患者中检出176个转移灶,6例未显示病灶的患者超声造影后检出肝内转移灶,46例患者（63、0％）超声造影较常规超声多检出119个转移灶（P〈0、01）,89、9％的新检出病灶〈2cm,最小者0．3cm。13例患者超声造影较增强CT多检出44个亚厘米转移灶（P〈0．01）,2例患者增强CT较超声造影多检出3个转移灶。结论 超声造影能够明显提高恶性肿瘤肝内小转移灶的检出能力,对亚厘米转移灶的检出优于增强CT,超声造影对恶性肿瘤临床分期及治疗方案的选择有较高的应用价值。     

超声造影对肝脏瘤样病变的诊断及鉴别诊断

目的 对肝脏瘤样病变的超声造影图像特征进行分析总结.方法 回顾性分析经病理及其他影像学方法 确诊的19例患者21个肝脏瘤样病灶的超声造影图像特征.结果 21个肝脏瘤样病灶中,超声造影确诊了16个,其中局灶性脂肪变性(FFC)7个,炎性假瘤(IPT)5个,局灶性结节增生(FNH)4个;另外4个局灶性结节增生超声造影提示肝脏良性占位病变;将1例炎性假瘤误诊为原发性肝癌(PLC).结论 病灶超声造影后延迟相的回声与周围肝实质相比较来判断其良恶性具有重要价值.     

实时灰阶超声造影术前评估宫颈癌

目的 观察宫颈癌的实时灰阶超声造影声像图表现,探讨超声造影在宫颈癌术前评估中的临床价值。方法 对30例宫颈癌患者进行实时灰阶超声造影检查,观察其造影剂灌注特征并进行术前的分期评估。将检查结果与常规超声及病理结果相对照。结果 宫颈癌实时灰阶超声造影声像表现分为四型:"同步型"、"点状或小片状增强型"、"块状型"和"快速扩散充盈型"。超声造影对宫颈癌的临床分期判断与术后病理符合率(21/30,70.00%)较经腹常规超声(12/30,40.00%)高,二者差异有统计学意义(P<0.05)。结论 实时灰阶超声造影有助于宫颈癌的诊断,可提供更好的影像学资料,为临床分期及制定治疗方案提供帮助。     

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。     

实时灰阶超声造影评价肝移植术前门脉系统栓子的价值

目的探讨实时灰阶超声造影在肝移植术前门脉系统栓子诊断及良恶性鉴别诊断中的价值。方法应用SonoVue造影剂及对比脉冲序列（CPS）技术对37例肝移植术前门脉系统栓子患者,共84条血管进行低机械指数实时灰阶超声造影检查。结果经过肝移植手术或螺旋CT门静脉成像证实,78条血管栓子形成（瘤栓50个,血栓28个）,6条血管通畅。超声造影诊断门脉系统栓子的敏感性98.7%,特异性100%,以栓子内动脉相早期造影剂灌注为标准,诊断门脉系统瘤栓的敏感性100%,特异性100%。结论实时灰阶超声造影可评价肝移植术前门脉系统的通畅性,提高栓子的检出率,并可鉴别栓子的良恶性,为肝移植手术方案的确定提供重要准确的信息。     

肝局灶性病变超声造影与增强CT和MRI表现的比较

目的 比较肝局灶性病变CEUS与增强CT(CECT)、增强MRI(CEMRI)表现的异同,并分析差异原因。方法 回顾性分析我院70例肝局灶性病变患者的影像资料,共75个病灶,包括肝细胞癌39个,转移性肝癌6个,胆管细胞癌6个,局灶性结节性增生6个,肝硬化结节5个,肝血管瘤4个,坏死结节4个,其他5个。阅片医师对各时相增强水平、增强类型、有无新发病灶等进行评价。采用Kappa检验评估CEUS与CECT/CEMRI表现及医师阅片结果间的一致性,并分析不一致的影像表现。结果 CEUS与CECT/CEMRI在病灶是否存在确切无增强的坏死或瘢痕区域方面一致性最高(Kappa=0.68);在门静脉期病灶相对于周围肝实质的主要增强水平方面一致性最低(Kappa=0.48)。44.23%(23/52)的恶性病灶及21.74%(5/23)良性病灶的CEUS与CECT/CEMRI表现不完全一致。结论 CEUS与CECT/CEMRI各时相表现一致性较好,差异性表现多集中于恶性病变。病灶影像表现存在差异的原因可能与对比剂不同及病理组织特征等有关。     

超声造影对小肾癌的诊断价值

目的 观察小肾癌(SRCC)超声造影表现及其临床应用价值.方法 分析64例经手术病理证实的小肾癌的常规超声及超声造影资料,比较两种方法 对小肾癌的诊断率、假包膜及坏死灶显示率以及反映病灶血供的能力等.结果 SRCC多为富血供病灶,呈"快进快出、高增强"的造影表现.超声造影较常规超声正确诊断率更高,能有效地反映病灶的血流灌注特征,并敏感显示病灶的假包膜及坏死灶.结论 实时灰阶超声造影对诊断SRCC有一定的临床价值.     

容积超声造影对肝肿瘤射频消融效果的评估

目的探讨容积超声造影评估肝肿瘤射频消融效果的价值。方法对22只新西兰白兔肝脏VX2肿瘤和22例肝癌患者进行射频消融治疗,治疗前后分别进行二维及容积超声造影,所有患者治疗前后行增强CT检查,动物肝脏均做病理学检查。结果消融前所有病灶二维及容积超声造影均表现为早期动脉相病灶内均匀或不均匀高增强;消融后,动物实验中19个病灶的疗效判断二维超声造影与病理结果相同;22个病灶容积超声造影与病理结果相同;临床研究中20个病灶的疗效判断二维超声造影与增强CT相同,24个病灶容积超声造影结果与增强CT相同。结论容积超声造影有可能更好地评估肝脏肿瘤消融治疗效果。     

Focal solitary necrotic nodules in fatty liver: characteristics on conventional and contrast-enhanced ultrasonography

PurposeFocal lesions in fatty liver are difficult to diagnose using conventional ultrasonography (CVUS). The aim of this study was to investigate the characteristics of solitary necrotic nodules (SNNs) in fatty liver using CVUS and contrast-enhanced ultrasonography (CEUS) and to evaluate the diagnostic value of CEUS for SNNs in fatty liver.MethodsFifteen SNNs in the fatty liver of fifteen patients were examined by both CVUS and CEUS. The contrast agent SonoVue was used for CEUS. The characterization and shape of these SNNs in the fatty liver were analyzed using CEUS.ResultsCVUS revealed eight oval-shaped, six irregularly shaped, and one wedge-shaped SNN in the fatty liver. The six irregularly shaped lesions on CVUS were revealed to comprise four gourd-shaped, one serpiginous, and one 3-pin socket-shaped nodule on CEUS. One of these SNNs showed a subcapsular wedge shape, with peripheral and distinct internal septal hyperenhancement in the arterial phases that washed out in the portal phase; moreover, most areas of th lesion showed no internal enhancement in any of the three phases. Fourteen of the lesions were characterized as lacking internal enhancement, and 12 of them had mild–moderate peripheral thin enhancement in the arterial phases. Twelve of the 15 nodules could be considered for diagnosis as SNNs by CEUS, which was further proved by US-guided biopsy and histopathology. However none of them could be considered for diagnosis as SNNs by CVUS.ConclusionsCEUS is a valuable tool for visualizing the characteristics of SNNs in fatty liver to improve the differential diagnosis.     

Contrast-enhanced ultrasonography for blood flow detection in hepatocellular carcinoma during lenvatinib therapy

Purpose

Blood flow reduction after initiation of lenvatinib therapy may not always indicate tumor necrosis. This study aimed to compare the blood flow detectability of contrast-enhanced ultrasonography (CEUS), contrast-enhanced computed tomography (CT), and contrast-enhanced magnetic resonance imaging (MRI) in hepatocellular carcinoma (HCC) during lenvatinib therapy.

Methods

A total of 12 cases underwent CEUS and contrast-enhanced CT/MRI within 2 weeks during lenvatinib therapy. Vascularity on CEUS and CT/MRI was compared.

Results

At the time of CEUS examination, the median period from the start of lenvatinib was 227?±?210 (31–570) days. CEUS showed hyperenhancement in eight cases (66.7%), hypoenhancement in two cases (16.7%), and no enhancement in one case (8.3%), while CT/MRI showed hyperenhancement in one case (8.3%), ring enhancement in three cases (25.0%), and hypoenhancement in eight cases (66.7%) (p?=?0.007). Transarterial chemoembolization (n?=?3), radiofrequency ablation (n?=?2), and stereotactic body radiation therapy (n?=?2) were performed after blood flow detection by CEUS.

Conclusions

The viability of the HCC should be confirmed using CEUS when contrast-enhanced CT/MRI reveals lesion hypoenhancement during lenvatinib therapy.

     

Contrast-enhanced US of the prostate with time/intensity curves: Preliminary results

PurposeTo evaluate the diagnostic performance of ultrasonography using second-generation contrast agent in the study of patients with focal prostate lesions and increased serum prostate-specific antigen (PSA) level.Materials and methodsSix consecutive patients (age range: 72–87 years) with increased PSA (≥4 ng/ml) underwent transrectal ultrasonography (TRUS) followed by contrast-enhanced ultrasonography (CEUS) with injection of second-generation contrast agent. All patients showed areas of abnormal echostructure suspicious for neoplastic lesions. On the basis of CEUS, a time/intensity curve of the suspected area was compared to that of a normal-appearing distant area of the gland and to the results of biopsy of the hypoechoic area.ResultsAt CEUS two different patterns of enhancement were identified and considered to be significant: pattern 1 characterized by a rapid rise in the time/intensity curve of the suspected area compared with the normal gland. Two out of six patients had this pattern and biopsy showed cancer in the biopsied area. Pattern 2 was characterized by a similar rise in the time/intensity curve of the suspected area compared with the normal gland. Four out of six patients had this pattern and biopsy showed prostatitis in the biopsied area.ConclusionsCEUS using second-generation contrast agent can on the basis of time/intensity curves show differences in vascularization in normal and pathological tissue. Evaluation of the two patterns seems to be useful for identifying areas requiring biopsy, particularly when peripheral hypoechoic areas are observed at TRUS. Our data need to be confirmed in a larger patient population.