超声造影检查原发性小肝癌的影像学表现及与病理特征的关系

目的 分析超声造影检查对原发性小肝癌(PSHC)的影像学表现及与病理特征的关系.方法 分析经手术或穿刺活检确诊的99例PSHC患者的临床资料,计算超声造影检查诊断PSHC的符合率,并比较不同分化程度PSHC患者超声造影的增强时间、达峰时间和消退时间,分析不同病理类型PSHC与超声造影各时相回声强度的关系.结果 99例PSHC患者共121个病灶,经超声造影检查诊断为PSHC共111个病灶,符合率为91.74％.不同分化程度PSHC患者造影剂增强时间、达峰时间比较,差异均无统计学意义(P﹥0.05);随PSHC分化程度的降低,消退时间逐渐缩短,差异有统计学意义(P﹤0.01).梁索型、假腺管型PSHC动脉相主要表现为高增强,门脉相和延迟相主要呈等增强或低增强,呈典型"快进快出"模式;实体型PSHC动脉相呈高增强,门脉相、延迟相均呈低增强;纤维硬化型PSHC动脉相以高增强或等增强为主,门脉相、延迟相多呈高增强.不同病理类型PSHC各时相回声增强模式比较,差异均有统计学意义(P﹤0.05).结论 PSHC超声造影影像学表现及病理特征关系密切,不同分化程度、病理类型PSHC的超声造影结果各有其特征性,可为临床诊断与分级提供可靠的依据.     

超声造影对典型与非典型肝癌的鉴别诊断

目的 探讨超声造影诊断典型与非典型肝癌的声像学特征.方法 选择行肝脏占位性病变超声造影患者148例,其中不符合欧洲超声造影剂指导原则中原发性肝癌典型表现的患者47例作为非典型肝癌组,符合原发性肝癌典型表现者80例作为典型肝癌组.所有病例经病理检查确诊,比较2组与病理检查结果的一致性和2组声像学的不同.结果 超产造影与病理检测结果一致性比较,Kappa =0.784,两者诊断一致性较好.超声造影诊断典型肝癌的准确率为98.75％,诊断非典型肝癌的准确率为95.74％,两者差异无统计学意义(x2=0.847,P ＞0.05).典型肝癌和非典型肝癌开始增强时间和持续时间比较,差异无统计学意义,JPP＞ 0.05.典型肝癌和非典型肝癌开始消退时间比较,差异具有统计学意义(P＜0.05).非典型肝癌组与典型肝癌组Ⅰ型高分化者(x2=0.554)、Ⅱ～Ⅲ型低分化者(x2=0.478)动脉期增强表现比较,差异无统计学意义,P均＞0.05.门脉期,非典型肝癌组和典型肝癌组Ⅰ型高分化者表现为等回声的比例(x2 =6.987)、Ⅱ～Ⅲ型(x2=6.014)比较,差异具有统计学意义,p均＜0.05;非典型肝癌组与典型肝癌组Ⅰ型(x2=6.845)、Ⅱ～Ⅲ型(x2=5.995)的增强方式比较,P均＜0.05,差异具有统计学意义.结论 超声造影可敏感地反映肝肿瘤的血流动力学特性,因对不同分化程度的肝癌有不同的造影表现而可对典型与非典型肝癌进行鉴别诊断.     

小肝癌的超声造影特征及其与病理分化程度相关性的临床研究

目的 探讨小肝癌的超声造影灌注特征与病理的相关性及其临床价值。方法 对常规超声发现的369个肝脏占位性病变行超声造影检查,分析其造影显像特征,并与病理结果进行比较。结果（1）与病理学诊断的恶性病灶245个和良性病灶124个进行对照,超声造影诊断小肝癌的灵敏度为98.8％（242／245）,特异度92.7％（115／124）,准确度96.7％（357／369）,约登指数0.92,阳性似然比13.7,阴性似然比0.013。（2）小肝癌的超声造影特征性表现为动脉早期快速增强,动脉中晚期或门脉早期快速廓清,呈快进快退表象;其中肝脏恶性病灶的快进快退表现占87.2％（219／251）,与良性病变的1.7％（2／118）比较,差异有统计学意义（P＜0.05）。（3）不同分化程度小肝癌的超声造影增强时间及达峰时间差异无统计学意义（P＞0.05）;高、中、低分化小肝癌的廓清时间分别为（102.4±2.36）s、（76.02±3.88）s和（49.40±4.95）s,分化程度高者的开始廓清时间明显晚于分化程度低者（P＜0.05）。结论 超声造影对小肝癌的诊断及其病理分化程度的评价具有重要的临床价值。     

超声造影对小肝癌的临床诊断价值

目的 探讨超声造影对小肝癌的临床诊断价值.方法 收集90例肝肿瘤患者,观察肝肿瘤病灶造影前后的良恶性情况,并对小肝癌病灶超声造影增强及消退开始时间进行记录.结果 造影前后肝肿瘤病灶良恶性评分差异有统计学意义(P＜0.05);低分化癌、透明细胞癌、高分化癌造影增强和消退开始时间差异有统计学意义(P＜0.05).结论 超声造影技术对肝脏肿瘤血流灌注特点具有更强的检测能力,可显著提高小肝癌的诊断率,值得进一步应用推广.     

超声造影评估原发性与转移性小肝癌的血流动力学比较研究

【摘 要】目的 探讨原发性和转移性小肝癌超声造影的血流动力学差异。方法 回顾性分析经病理及临床证实的210个原发性小肝癌和93个转移性小肝癌的超声造影表现,比较两组小肝癌在动脉期、门脉期和延迟期增强表现的异同。结果（1）303个小肝癌病灶,超声造影表现为动脉期快速增强、门脉期或延迟期消退,转移性小肝癌增强达峰时间和开始消退呈低回声时间明显早于原发性小肝癌（P＜0.05）。（2）超声造影动脉期显示,95.7％（201／210）的原发性和2.3％（2／93）的转移性小肝癌呈高回声（P＜0.05）,门脉期及延迟期显示原发性和转移性小肝癌的血流动力学变化差异无统计学意义（P＞0.05）。（3）在超声造影动脉期增强形态上,原发性小肝癌和转移性小肝癌分别有93.4％（196／210）和35.5％（33／93）的病灶呈整体均匀性增强（P＜0.05）;转移性小肝癌中,54.8％（51／93）的病灶周边呈环状或不规则状增强,明显高于原发性小肝癌的5.2％ （11／210）,差异有统计学意义（P＜0.05）。结论 转移性和原发性小肝癌在超声造影动脉期均呈快速增强,但在增强方式和开始消退呈低回声的时间上均存在一定差异。超声造影为原发性与转移性小肝癌的诊断与鉴别诊断提供了重要的影像学依据。     

肝硬化继发小肝癌的超声造影特征及临床意义

目的 探讨肝硬化继发小肝癌的超声造影特征及临床意义.方法 选取300例肝硬化背景下肝脏占位患者为研究对象,全部患者均接受肝脏超声造影检查,以术后组织病理学检测结果为金标准,计算超声造影对肝硬化继发小肝癌的诊断效力.观察比较中-低分化癌,高分化癌和肝硬化不典型再生结节的强化方式、开始增强时间、增强峰值时间及开始消退时间的差异.结果 超声造影对肝硬化继发小肝癌的诊断灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为96.3%、89.1%、97.5%、84.5%和95.0%.肝硬化不典型再生结节的开始增强时间[(25.4±7.4)s vs(16.1±4.5)s vs(17.5±5.4)s]、增强峰值时间[(53.6±12.2)s vs(24.3±7.6)s vs(26.5±8.6)s]及开始消退时间[(209.4±53.6)s vs(58.4±16.5)s vs(155.1±34.2)s]均长于中-低分化癌和高分化癌,差异有统计学意义(P﹤0.05);高分化癌的开始消退时间长于中-低分化癌[(155.1±34.2)s vs(58.4±16.5)s],差异有统计学意义(P﹤0.05).中-低分化癌的增强方式以快进快出强化为主,比例为92.81%;高分化癌的增强方式以快进慢出强化为主,比例为89.74%;肝硬化不典型再生结节的增强方式以与肝实质同步强化为主,比例为85.45%.结论 在肝硬化继发小肝癌的诊断中,超声造影诊断的准确度较高,值得临床推广及应用.     

超声造影在良恶性子宫肿瘤诊断中的临床价值

目的探讨超声造影在良恶性子宫肿瘤诊断方面的临床应用价值。方法采用低机械指数灰阶谐波超声造影技术,分析经手术及病理证实的62例子宫肿瘤的超声造影强化特点并行时间-强度曲线分析。结果病理诊断良性病变34例,恶性病变28例,超声造影诊断符合率为90.3%。子宫良、恶性肿瘤的超声造影强化方式及时间-强度曲线形态各具不同特征,造影参数中始增时间、达峰时间、峰值强度在子宫良、恶性肿瘤组比较,差异有统计学意义(P<0.05)。结论超声造影能显示肿瘤血流灌注情况,可用于提高子宫肿瘤良恶性鉴别诊断。     

彩色多普勒超声血流动力学特征对鉴别诊断原发性和转移性肝癌的价值

目的 探讨彩色多普勒超声通过血流动力学特征对原发性肝癌和转移性肝癌的鉴别价值.方法 选取60例确诊为原发性肝癌和60例转移性肝癌患者,所有患者行彩色多普勒超声检查,对比分析两者血流动力学特征的异同.结果 原发性肝癌的血流动力学参数的肝动脉直径、肝动脉峰值、门静脉流速以及肝动脉最小流速均与转移性肝癌存在明显差异,具有统计学意义(P＜0.05);但2组患者的肝动脉血流阻力指数差异不具统计学意义(P＞0.05).原发性肝癌内部血流信号检出率为88.3％,周边血流信号检出率为100.0％;转移性肝癌内部血流信号检出率为48.3％,周边血流信号检出率为70.0％,2组差异具有统计学意义(P＜0.05).原发性肝癌血流特点为高速高阻型,转移性肝癌则为低速高阻型.结论 彩色多普勒超声通过血流动力学参数对原发性肝癌和转移性肝癌鉴别特异性较好,具重要临床使用价值.     

超声造影LI RADS分类与小肝癌分化程度及病理类型的相关性分析#br#

【摘要】目的探讨超声造影肝脏影像报告和数据管理系统（LI RADS）分类与小肝癌分化程度及病理类型的相关性。方法回顾性分析2019年1月至2022年1月亳州市中医院收治的82例行肝脏超声造影检查的肝脏局灶性病变患者临床资料，比较不同LI RADS类别肿瘤分化程度及病理类型，采用Spearman相关性分析小肝癌患者LI RADS类别与肿瘤分化程度及病理类型的关系。结果不同LI RADS类别患者病灶直径、微血管侵犯比较，差异无统计学意义（P>005）；不同LI RADS类别患者病灶部位比较差异有统计学意义（P<005），与LI RADS 5患者比较，LI RADS M患者左叶占比较高（P<005），右叶占比较低（P<005），LI RADS 3患者右叶占比较低（P<005），尾叶占比较高（P<005）；不同LI RADS类别肿瘤分化程度比较，差异有统计学意义（P<005），LI RADS 5患者低分化占比低于LI RADS M、LI RADS 4患者（P<005），LI RADS 5患者高分化占比高于LI RADS M、LI RADS 4患者（P<005）；不同LI RADS类别患者病理结果比较，差异有统计学意义（P<005），LI RADS 5患者HCC阳性预测值更高（P<005）。结论超声造影LI RADS分类与小肝癌分化程度及病理类型相关，能够为临床初步诊断小肝癌提供参考依据。 在甲状腺切除术应用甲状腺背侧支血管对喉返神经进行定位，可有效缩短手术时间，减少术中出血量，降低喉返神经损伤的发生风险。     

腹部超声、CT联合血清甲胎蛋白诊断原发性肝癌的临床价值

目的:研究腹部超声、CT联合血清甲胎蛋白（AFP）诊断原发性肝癌的价值。方法:回顾性分析我院于2017年1月至2018年1月期间收治的50例确诊原发性肝癌患者作为肝癌组,另选取同期收治的50例肝脏良性肿瘤患者作为良性组及50例来院参加健康体检的志愿者作为对照组。以病理结果为标准,对比三组受检者的腹部超声、CT诊断阳性率,血清AFP水平,联合诊断的敏感度、特异度、阳性预测值及阴性预测值,并研究联合诊断不同分期原发性肝癌的阳性率。结果:三组受检者对比,肝癌组患者的腹部超声、CT诊断阳性率及AFP水平均高于良性组及对照组,且良性组高于对照组,差异均有统计学意义(P＜0.05)。腹部超声、CT及AFP联合诊断Ⅰ-Ⅱ期及Ⅲ-Ⅳ期肝癌的阳性率高于单项诊断,差异均有统计学意义(P＜0.05)。诊断效能对比,腹部超声、CT及AFP联合诊断的特异度、敏感度、阴性预测值及阳性预测值均高于单项诊断,差异均有统计学意义(P＜0.05)。结论:腹部超声、CT联合血清AFP诊断原发性肝癌,较各单项诊断阳性率高,且联合诊断的敏感性及特异性更好,可有效明确肝癌分期,值得在临床上推广。     

肝超声造影监测和早期诊断微小肝癌的应用价值

背景与目的：我国肝癌发病率高,原发性肝癌常在肝硬化的基础上发生,早期诊断较为困难。本研究应用实时超声造影对肝癌高危患者进行定期跟踪监测,探讨其早期发现和诊断微小肝癌的临床应用价值。方法：2011年2月-2013年11月针对320例肝癌高危患者进行定期的肝常规超声检查和追踪定位的肝超声造影检查,根据肝内病灶在超声造影不同时相的增强表现特点鉴别诊断其良恶性。结果：320例肝癌高危患者定期随访中,经肝超声造影发现和诊断微小肝细胞癌20例,并经手术病理证实,包括直径≤1.0 cm肝癌7例、1.1~2.0 cm肝癌13例。其中6例(30.0%)呈不典型的“快进同出”型表现;病灶小,灰阶超声上呈等回声是超声造影表现不典型的主要因素。结论：常规超声和超声造影对肝癌高危患者的定期跟踪监测,可早期发现微小肝癌,使患者得到及时治疗。     

超声造影灌注时相分析在监控肝硬化结节演变和恶变中的临床价值

背景与目的：原发性肝癌多在慢性肝炎、肝硬化的基础上发生,一般认为,肝硬化结节（cirrhotic nodule,CN）、异型增生结节（dysplastic nodule,DN）等一系列过程,最终演变为肝细胞癌（hepatocellular carcinoma,HCC）。应用实时超声造影对肝硬化患者进行定期跟踪监测,探讨超声造影在CN演变和HCC早期诊断中的价值。方法：在2007年3月—2017年12月于复旦大学附属中山医院就诊的9 550例慢性乙肝患者中,选取定期超声随访的392例患者的551枚结节作为研究对象,以病理学检查及影像学诊断为标准,分析不同性质结节在超声造影灌注时相的增强表现特点。结果：肝内551枚结节中确诊微小HCC（≤2 cm）55枚、DN 19枚和CN 477枚。常规超声显示,肝内CN、DN和HCC均以低回声多见,分别占61.6%（294/477）、78.9%（15/19）和67.3%（37/55）。超声造影显示,CN的造影特征以等-等-等的增强方式为主,占89.5%（427/477）;DN的造影特征以低-等-等的增强方式最多见,占52.6%（10/19）;微小HCC的造影特征则以高-等-等和高-等-低的增强方式最多见,占85.5%（47/55）。超声造影诊断CN、DN和HCC的准确率分别为93.3%、78.9%和85.5%。结论：超声造影灌注时相分析可客观地反映肝内CN、DN及微小HCC的不同灌注模式,应用超声造影定期监测肝硬化的结节,可及时预警和早期诊断微小HCC,改善患者预后。     

Evaluation of contrast-enhanced ultrasonography using perfluorobutane (Sonazoid(®)) in patients with small hepatocellular carcinoma: comparison with dynamic computed tomography

This study aimed to elucidate the efficacy of contrast-enhanced ultrasonography (CEUS) with perfluorobutane (Sonazoid(?)) in the diagnosis of hepatocellular carcinomas (HCCs), particularly small HCCs, by comparing the results with dynamic computed tomography (Dy-CT). Seventy-nine nodules in 69 patients with chronic liver disease, suspected as HCCs were studied. The nodules were selected based on the results of B-mode ultrasonography and/or Dy-CT conducted between January and August 2007. The nodules were divided into two groups: the S-group with tumors ≤2 cm (49 nodules), and the L-group with tumors >2 cm (30 nodules). Typical HCCs were defined, and the nodules were enhanced and shown as defects in the arterial and late phase of Dy-CT, respectively. Target lesions were scanned using CEUS, and the results were compared with those of Dy-CT. The L-group nodules diagnosed as HCCs using Dy-CT were also diagnosed as HCCs using CEUS. In the S-group, the diagnostic sensitivity of CEUS was 94.7% and the specificity was 81.8%. We diagnosed two liver tumors that were detected by CEUS but not by Dy-CT; biopsies revealed one tumor to be a well-differentiated HCC and the other to be an atypical adenomatous hyperplasia. The sensitivity and specificity of CEUS against HCC were high even in the small-size HCCs. Thus, Sonazoid is useful in the screening for small HCCs.     

Diagnostic role of contrast-enhanced ultrasonography versus conventional B-mode ultrasonography in cirrhotic patients with early hepatocellular carcinoma: a retrospective study

BackgroundEarly diagnosis of hepatocellular carcinoma (HCC) is very important for the prognosis of patients. However, there are very few studies that compared the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) and B-mode ultrasonography for early HCC in cirrhotic patients.MethodsThis retrospective study included cirrhotic patients, who were suspected of early HCC between January 2020 and June 2021. The diagnosis of patients was based on the pathology results of surgery or biopsy. Demographic and clinical characteristics of included patients were recorded. The diagnoses of suspected lesions using both types of ultrasonography were recorded, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of early HCC in cirrhotic patients were calculated.ResultsEventually, 137 patients with solitary lesions in the liver were included in this study, including 89 patients diagnosed with HCC and 48 patients diagnosed with non-HCC. The median diameter of suspected lesions was 26 mm, and the median level of alpha fetoprotein (AFP) was 37.2 ng/mL. When comparing the demographic and clinical characteristics of cirrhotic patients with HCC and non-HCC, it was found that patients with HCC had significantly higher levels of AFP than those with non-HCC (P=0.03). The sensitivity, specificity, PPV, NPV, and accuracy of CEUS in early HCC were 73%, 93.8%, 95.6%, 65.2% and 80.3%, respectively. In CEUS, all of these parameters were much higher than those in B-mode ultrasonography, i.e., 64%, 75%, 82.6%, 52.9%, and 67.9%. It was also found that the diagnostic accuracy of CEUS was much higher than that of B-mode ultrasonography especially regarding lesions <20 mm. To further improve the sensitivity of CEUS in early HCC, AFP was combined with CEUS for the diagnosis of early HCC. As a result, the sensitivity, specificity, PPV, NPV, and accuracy of CEUS combined with AFP level were 83.1%, 87.5%, 92.5%, 73.7%, and 84.7%, respectively.ConclusionsOur study confirmed that CEUS’ diagnostic accuracy for early HCC in cirrhotic patients was significantly higher than that of B-mode ultrasonography. However, the sensitivity of CEUS needs to be improved further, and the combination of CEUS and AFP level may be a potential solution.     

Contrast-enhanced ultrasonography for the diagnosis of small hepatocellular carcinoma: a meta-analysis and meta-regression analysis

The aim of this study is to determine the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) for diagnosis of small (≤2 cm in diameter) hepatocellular carcinoma (HCC) through a meta-analysis of published studies. A comprehensive literature search of PubMed, Embase, Web of Science, and China BioMedicine databases was conducted on articles published before 1 March 2013. Data from selected studies were pooled to yield summary sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curve. Statistical analyses were performed using Meta-Disc version 1.4 and STATA version 12.0 softwares. Fifteen studies were included with a total of 908 cirrhotic patients with 1,032 small hepatic nodules. All lesions were histologically confirmed through liver biopsies after CEUS. The pooled sensitivity was 0.81 (95 % CI?=?0.78–0.85); the pooled specificity was 0.86 (95 % CI?=?0.82–0.89). The pooled positive LR was 5.90 (95 % CI?=?3.90–8.94); the pooled negative LR was 0.20 (95 % CI?=?0.14–0.29). The pooled DOR was 37.07 (95 % CI?=?24.79–55.44). The area under the SROC curve was 0.93 (SE?=?0.01). Meta-regression analysis showed that the number of lesions may be a major source of heterogeneity. No publication bias was detected in this meta-analysis. This meta-analysis indicates that CEUS is a useful diagnostic tool with high sensitivity and specificity for identifying small HCC.     

Quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma before and after transcatheter arterial chemoembolisation using contrast-enhanced ultrasound

To conduct a quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolisation (TACE) using contrast-enhanced ultrasound (CEUS). From 2013 June to 2105 October, a total of 106 HCC patients undergoing TACE were recruited. CEUS was performed before and after TACE to determine time–intensity curve (TIC) and perfusion quantitative parameters of the HCC lesions and surrounding liver parenchyma. Quantitative perfusion parameters were obtained using the region of interest method. The microcirculation blood perfusion was measured with a blood analysis system and microcirculation microscope. Tumour microvessel density (MVD) was detected by CD34 immunohistochemistry. Compared with surrounding liver parenchyma, the HCC lesions had earlier arrive time (AT), time to initial peak (TTP) and acceleration time, and faster slope of rise time (a3), but no differences were observed in mean transit time (MTT), slope of decrease to half of peak (a2), peak intensity (PI), increased signal intensity (ISI), area under the curve (AUC) and blood flow (BF). There were significant differences in PI, a3, ISI, AUC and BF in HCC lesions between before and after TACE. The high blood viscosity, low blood viscosity, plasma viscosity and integral viscosity in HCC lesions increased after TACE, but the velocity of nailfold microcirculation decreased after TACE. The MVD of well-differentiated HCC lesions was higher than that of poor-differentiated HCC lesions under a light microscope at 50× magnification. However, no significant differences were found in MVD between well-differentiated and poor-differentiated HCC lesions under a light microscope at 100× and 200× magnifications. The PI, ISI, AUC and BF of poor-differentiated HCC lesions were significant lower than those of well-differentiated HCC lesions, but there were no differences in AT, TTP, ACU, MTT, a2 and a3. In conclusion, these results indicate that quantitative CEUS perfusion parameters could be useful tools for assessing the efficacy of TACE for HCC.