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LI-RADS在慢性肝病患者肝局灶性病变恶性风险评估中的价值

目的　探讨超声造影肝脏影像报告与数据系统（LI-RADS）在慢性肝病患者肝局灶性病变恶性风险评估中的应用价值。方法　回顾性分析2018年1月至2020年10月至上海交通大学医学院附属瑞金医院行肝脏超声造影检查的具有肝细胞肝癌（HCC）高危因素的肝局灶性病变151例患者197枚结节的临床和影像学资料,根据美国放射学院（ACR）LI-RADS（2017版）标准对结节进行超声造影LI-RADS分级。目标病灶的诊断均经组织病理、CT或MRI增强诊断并随访证实。利用诊断试验公式计算超声造影LI-RADS分类标准诊断肝脏恶性病灶的灵敏度、特异度、阳性预测值、阴性预测值和准确度。结果　入组197枚结节中恶性病灶126枚、良性病灶71枚。超声造影LI-RADS诊断LR-1类结节12枚、LR-2类24枚、LR-3类39枚、LR-4类14枚、LR-5类90枚、LR-M类18枚。以LR-5类为HCC诊断标准时,其诊断HCC的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为77.57%（83/107）、92.22%（83/90）、92.22%（83/90）、77.57%（83/107）、84.26%（166/197）;以LR-4+5类为HCC诊断标准时,其诊断HCC的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为86.92%（93/107）、87.78%（79/90）、89.42%（93/104）、84.95%（79/93）、87.31%（172/197）;2个标准的诊断价值差异无统计学意义（P均＞0.05）。LR-M类诊断肝脏非HCC恶性病灶的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为73.68%（14/19）、97.75%（174/178）、77.78%（14/18）、97.21%（174/179）及95.43%（188/197）。结论　超声造影LI-RADS为超声造影的标准化评估提供了参考标准,对HCC具有较好的诊断效能,对肝脏非HCC恶性病灶也有较高的诊断特异度和准确性。     

低声压动态超声造影技术对肝脏局灶性病变诊断价值的研究

目的:评价低声压超声造影技术在肝占位性病变中的鉴别诊断价值.方法:应用Sonovue超声造影剂对181例共209个肝脏病灶行超声造影,并对造影结果进行分析.病灶经病理证实或随访6～12个月证实.结果:144个原发性肝细胞性肝癌(HCC)病灶和血管肉瘤、胆管细胞癌、结核各1个病灶呈现"快进快出"模式;25个血管瘤病灶呈现"慢进慢退";21个肝硬化不典型增生结节,动脉期无增强,门脉期增强;5例转移性肝癌均为快速廓清,但动脉相增强方式不同;1例FNH和炎性假瘤呈"快进慢出";5例脓肿为快速融合性增强;3例炎性假瘤2例结核未见造影增强.结论:低声压超声造影技术对肝脏局灶性病变定性诊断提供一种选择模式,超声造影较CDFI可显著提高局灶性肝脏病变的发现和定性诊断率.     

HBV相关肝硬化结节的多模态超声诊断价值

目的采用多模态超声对HBV相关肝硬化背景内结节进行评估并分类。方法选取2013年10月~2016年10月于浙江中医药大学附属杭州市西溪医院就诊的HBV相关性肝硬化患者200例,其中病理诊断为增生结节(RN)者51例,不典型增生结节(DN)者57例,其中低级别不典型增生结节(LGDN)27例,高级别不典型增生结节(HGDN)30例,肝细胞肝癌(HCC)为17例,均行多模态二维超声、彩色多普勒、超声造影检查,对比不同病理类型的结节多模态超声特征性表现,进一步将肝硬化背景肝内结节分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4类。采用χ~2检验比较不同大小、超声造影不同增强模式肝硬化背景肝内DN及HCC检出率的差异。结果直径2.0~3.0 cm结节25个,均为HCC与DN;直径1.0~2.0 cm结节94个,4个为HCC,24个为HGDN;直径1.0 cm结节6个,全部为RN;不同大小肝硬化背景肝内结节HCC与DN检出率差异有统计学意义(P0.05)。RN结节主要以"等进等出"增强模式为主,LGDN主要以"慢进等出"增强模式为主,HGDN及HCC主要以"快进快出"增强模式为主,不同组间不同的增强模式差异有统计学意义(P0.05);而HCC与HGDN在造影剂进入时间、达峰时间、流出时间上差异有统计学意义(P0.05),Ⅲ类、Ⅳ类结节在DN及HCC检出率上差异有统计学意义(P0.05)。结论多模态超声对于HBV相关肝硬化肝内结节进行评估、分类,对于HGDN及HCC早期诊断有一定帮助。     

实时超声造影对肝脏占位性病变70例诊断的临床价值

目的 观察肝脏占位性病变超声造影后的特点,评估超声造影检查对肝脏占位性病变诊断的临床价值.方法 回顾性分析70例共91个病灶的超声造影表现.结果 原发性肝癌(HCC)动脉相早期呈整体增强,呈快进快出高增强;转移性肝癌动脉相早期周边先环状强化或直接整体强化,门脉相及延迟相迅速消退,呈"黑洞"征表现;胆管细胞癌动脉相早期周边开始强化,至门脉相早期强化范围进一步扩大,呈慢进快出高增强.肝血管瘤呈典型的慢进慢出高增强,肝腺瘤呈快进慢出低增强,肝脓肿呈网格状快进快出低增强.局灶性结节性增生表现为"轮辐状"快进慢出高增强,不均质脂肪肝及肝硬化结节呈等增强,其增强方式与周围肝实质一致.结论 不同肝脏占位性病变有不同的超声造影特点,超声造影检查有助于肝脏占位性病变的鉴别诊断.     

超声造影LI-RADS分类标准对肝细胞癌的诊断价值

  目的  探讨超声造影肝脏影像报告与数据系统(liver imaging reporting and data system,LI-RADS)对肝细胞癌(hepatocellular carcinoma,HCC)的诊断效能,评估其在HCC诊断中的应用价值。  方法  选取2018年9月—2020年6月于蚌埠市第三人民医院就诊的具有HCC高危因素患者150例共163个肝脏局灶性病变的超声造影资料,由4名具有5年以上肝脏超声造影经验的医师按照超声造影常规法标准和LI-RADS分类法标准分为2组,分别对163个病灶进行诊断。以病理结果为金标准,计算敏感性、特异性、阳性预测值、阴性预测值、诊断符合率,绘制ROC曲线比较2组的诊断效能。  结果  163个病灶经病理证实HCC为122个,非HCC恶性病变16个,良性病变25个。常规法诊断HCC符合率为87.1%(142/163),曲线下面积(AUC)为85.7%。LI-RADS分类法中LR-5类诊断HCC特异性最高(95.1%)但敏感性偏低(72.1%),若将LR-4+LR-5类诊断为HCC,其敏感性(98.4%,120/122)、特异性(82.9%,34/41)、诊断符合率(94.5%,154/163)及AUC(90.6%)均高于常规法。分类法诊断准确性优于常规法,二者差异具有统计学意义(χ2=4.654, P=0.031)。  结论  超声造影LI-RADS分类标准可以提高HCC诊断符合率,具有较高的诊断价值。      

慢性肝炎基础上≤2cm肝局灶性病变的超声造影与增强CT特征比较

目的对比分析慢性肝炎或肝硬化基础上≤2 cm肝局灶性病变(FLLs)的超声造影与增强CT特征,探讨超声造影在CT诊断阴性或动脉期无强化且伴有慢性肝病的FLLs诊断中的价值。方法回顾性分析经穿刺病理证实的25例伴有肝硬化或者慢性肝病的FLLs的临床资料,所有患者均行超声造影及增强CT检查,病灶直径≤2.0 cm。结果所有病灶CT无阳性发现或动脉期无高增强。超声造影显示8例动脉期呈高增强的病灶病理结果提示高分化肝细胞癌(HCC)5例和中分化HCC 3例;13例动脉期呈等增强的病灶病理结果提示不典型增生3例、高分化HCC 5例及增生结节5例;4例动脉期呈低增强的病变病理提示高分化HCC 1例、增生结节3例。门脉期及延迟期22例等增强的病灶病理结果提示高分化HCC 11例、不典型增生3例及增生结节8例,3例低增强的病灶病理结果提示中分化HCC。结论 CT诊断阴性或动脉期无强化且伴有慢性肝病的FLLs,其超声造影结果表现不同,但绝对不能排除恶性病变,应结合超声引导穿刺活检进一步排除恶性病变,更利于为患者提供早期治疗。     

实时超声造影在肝脏肿瘤鉴别诊断中的价值

目的评价超声造影技术在肝脏肿瘤诊断中的价值。方法应用超声造影技术检查47例肝脏肿瘤患者(良性肿瘤10例10个病灶;恶性肿瘤37例41个病灶)。观察注射第二代超声造影剂SonoVue后肝脏肿瘤的动态增强表现,并作出造影诊断。结果肝脏恶性肿瘤的超声造影表现为"快进快出";肝血管瘤的超声造影表现为"慢进慢出";肝局灶性结节性增生表现为早期动脉相强化,但持续时间较长;肝硬化结节与肝实质呈同步强化。结论超声造影能动态显示肝脏肿瘤不同时相的增强情况,对肝脏肿瘤的诊断、鉴别诊断有重要的临床应用价值。     

超声造影对肝硬化背景下小肝癌和增生结节的诊断价值

目的探讨在肝硬化背景下小肝癌和增生结节的超声造影特征。方法收集临床肝硬化背景下局灶性病变41例患者,共48个结节,观察病灶区对比剂的灌注过程及造影前后声像图特征进行分析,并与手术或超声引导下穿刺活检病理诊断结果进行比较。结果小肝癌结节40个,超声造影示均为动脉相快速充盈呈高增强,其中28个结节门脉相迅速减退呈低增强,即＂快进快退＂型,12个结节门脉相呈等增强,延迟期缓慢减退呈低增强,即＂快进慢退＂型。肝硬化增生结节8个,其中2个结节动脉相稍高增强,门脉相及延迟相呈等增强,6个动脉相无增强,门脉相及延迟相呈等增强。结论超声造影在肝硬化背景下对小肝癌与增生结节的鉴别诊断具有重要临床诊断价值。     

新型超声造影技术对微小肝癌诊断的价值

目的: 分析≤2 cm微小肝癌的超声造影增强模式,探讨超声造影新技术对微小肝癌的早期诊断价值.方法:应用新型超声造影剂SonoVue及CnTI实时灰阶超声造影匹配成像技术(CEUS)对392例肝脏局灶性病变行超声造影检查,其中经穿刺活检确认肝硬化合并≤2 cm 肝细胞癌(HCC),并有病理组织学分类诊断的36例38灶为本文研究对象.全部病例造影后即刻或半个月内均行穿刺活检或手术病理检查.最终确诊为中分化癌22个灶,高分化癌12个灶,透明细胞癌4个灶.结果:造影前常规超声仅对16个灶(42.1%)作出恶性诊断或可疑恶性.造影后38个HCC灶动脉期均不同程度增强;其中中分化癌22个灶均发生快速增强,并在实质期快速消退,呈典型的"快进快出"HCC增强模式;高分化癌12个灶中有9个灶(75.0%)呈"快进慢出"模式;透明细胞癌4个灶中1个灶呈"快进快出",1个灶呈"快进慢出"模式,2个灶呈"轻度慢进慢出"模式.根据CEUS后增强表现,本组76.3%(29个灶)被确认为恶性,18.4%(7个灶)诊断为可疑恶性,另2个≤1.5 cm灶(5.3%)造影增强不典型,未能获得定性诊断.结论:超声造影新技术对肝硬化背景下不同组织类型微小肝癌增强模式的认识为提高微小肝癌的诊断率提供依据.初步结果显示,新型超声造影可作为CT等影像学诊断的互补手段,在小肝癌的早期诊断中发挥重要作用,值得重视推广.     

超声造影LI-RADS在隐匿性乙肝患者肝细胞癌诊断中的应用

目的：探讨超声造影肝脏成像报告和数据系统（CEUS LI-RADS）对隐匿性乙肝感染（OBI）患者诊断肝细胞癌（HCC）的性能。方法：选取2018 年1月至2021年12月丽水市中心医院的334 例OBI患者新诊断的肝脏局灶性病变进行回顾性分析。根据CEUS LI-RADS对每个结节进行评估,且在甲胎蛋白（AFP）是否＞25 μg/L的患者中进行亚组分析。CEUS LI-RADS系统对肝癌的诊断性能分别通过灵敏度、特异度、精确度、阳性预测值（PPV）和阴性预测值（NPV）进行验证。结果：共有120例HCC（36.0%）,其中CEUS LI-RADS系统中的LR-4、LR-5和LR-M类分别有4例（占3.3%）、70例（占58.3%）和46例（占38.3%）。LR-5类诊断HCC的灵敏度、特异度、精确度、PPV和NPV分别为58.3%、88.8%、77.8%、74.5%和79.2%。AFP＞25 μg/L的OBI患者使用CEUS LI-RADS诊断HCC的灵敏度、特异度、精确度、PPV和NPV分别为63.3%、80.0%、65.7%、95.0%和26.7%。鉴于其高PPV,因此13.0%（40/308）OBI患者通过CEUS可高度怀疑HCC。结论：在AFP＞25 μg/L的OBI患者中,使用CEUS LR-5类作为诊断标准,可以有助于确诊HCC。     

应用肝影像报告和数据系统MRI分级标准诊断原发性肝癌的 诊断效能评价

目的：初步探讨肝影像报告和数据系统(liver imaging reporting and data system,LI-RADS)磁共振成像(magnetic resonance imaging,MRI)分级标准对原发性肝癌的诊断价值。方法：搜集2014年1月至2015年1月在中南大学湘雅医院术后病理证实的100例(原发性肝癌72例,再生结节4例,血管瘤13例,肝囊肿4例,肝脓肿3例,炎性假瘤2例,肝动静脉瘘1例,局限性脂肪变性1例)具有原发性肝癌高危因素患者的MRI影像资料,由3位影像学副教授在不知道病理结果的前提下,严格按照LI-RADS MRI分级标准对图像进行评阅,计算出LI-RADS MRI分级标准诊断原发性肝癌的敏感性、特异性及ROC曲线下面积。结果：应用LI-RADS MRI分级标准诊断100例患者为原发性肝癌的ROC曲线下面积为0.925。100例患者图像的肝病变分类中LR1类和LR2类20例,术后病理检查均为良性(阴性预测值为100%),31例LR3类中术后病理检查有25例为原发性肝癌,29例LR4类中术后病理检查有27例为原发性肝癌(阳性预测值为93.1%),20例LR5类中术后病理检查表明全部为原发性肝癌(阳性预测值为100%)。将LR3,4,5类归为阳性,则该分级标准的敏感性和特异性分别为100%和71.4%,ROC曲线下面积为0.925。若将LR4,5类归为阳性,则敏感性和特异性可以达到100%和90.9%,ROC曲线下面积为0.974。结论：采用LI-RADS的MRI分级标准诊断原发性肝癌有很好的敏感性及特异性,具有较高的诊断正确率。     

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。     

磁共振2018版与超声造影2017版肝脏影像报告数据系统对肝细胞癌的诊断效能对比

目的：探讨MRI肝脏影像报告和数据系统（MR v2018）与超声肝脏影像报告和数据系统（CEUSv2017）对肝细胞癌（HCC）的诊断效能差异。方法：前瞻性收集2019年8月至2021年7月间在丽水市中心医院就诊的153例HCC高危风险患者（173例病灶）的超声增强造影和磁共振增强检查资料,评估肝内病灶的影像特征和CEUS v2017与MR v2018类别,以病理或临床诊断为标准将病灶分为HCC组（119例）、其他肝脏恶性肿瘤（OM）组（20例）、良性病变组（34例）。采用Mann-Whitney U 检验比较MR v2018与CEUS v2017的LIRADS分类结果差异,χ2检验比较MR v2018与CEUS v2017分类标准诊断HCC或OM的灵敏度、特异度和准确度差异。结果：MR v2018与CEUS v2017 评估中HCC与OM的LI-RADS分类结果差异均无统计学意义（Z =-0.363、-1.705,P =0.717、0.088）。MR v2018与CEUS v2017中以LR-5标准诊断HCC的灵敏度均为63.9%（76/119）,特异度分别为98.1%（53/54）和92.6%（50/54）,准确度分别为74.6%（129/173）和72.8%（126/173）;以LR-4联合LR-5（LR-4/5）标准诊断HCC的灵敏度分别为74.8%（89/119）和84.9%（101/119）,特异度分别为94.4%（51/54）和70.4%（38/54）,准确度分别为80.9%（140/173）和80.3%（139/173）;以LR-M标准诊断OM的灵敏度分别为90.0%（18/20）和70.0%（14/20）,特异度分别为87.6%（134/153）和90.8%（139/153）,准确度分别 为87.9%（152/173）和88.4%（153/173）;两套系统在LR-4/5标准的特异度对比中MR v2018要显著高于CEUSv2017,差异有统计学意义（P =0.001）。结论：MR v2018与CEUS v2017的LR-5 标准诊断HCC、LR-M标准诊断OM均具有相近的诊断效能;而LR-4/5标准在诊断HCC的特异度方面MR v2018要高于CEUS v2017。     

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.     

High mechanical index post-contrast ultrasonography improves tissue structural display of hepatocellular carcinoma

Background The advent of second generation agent-SonoVue and low mechanical index real-time contrast enhanced ultrasonography （CEUS） imaging have been shown to improve the diagnostic performance of uhrasonography in hepatocellular carcinoma （HCC）. But no report has described the effect of high mechanical index （MI） post-CEUS. This study aimed to investigate the value of post-CEUS in displaying tissue structures of HCC. Methods Seventy-six HCCs in 65 patients were included in the study. Each patient underwent three scans, high-MI （ MI ： 0. 15 - 1.6 ） pre-contrast ultrasound, low-MI （ MI ： 0. 04 - 0. 08 ） CEUS with contrast agent SonoVue, and high-MI post-contrast ultrasound, which was performed within 3 minutes after CEUS. The size, boundary, echogenicity, internal echotexture and posterior acoustic enhancement of the HCCs in the conventional scans before and after CEUS were evaluated. According to pathological evidence, diagnosis rates of pre-contrast, CEUS and post-contrast scans were determined and compared. The potential mechanism of post-contrast ultrasound imaging was also discussed. Results Compared with pre-contrast, post-contrast ultrasound showed improvement in image quality in most HCCs： twenty-six （34. 2% ） more lesions showed well defined margins and fourteen （18.4%） more nodules showed halo sign; twenty-three （30. 3% ） lesions demonstrated enlarged in sizes; changes in echogenicity were seen in 30 lesions （39.5%） ; eighteen （23.7%） more lesions showed heterogenecity and 20 （26. 3% ） more lesions showed “mosaic”or “nodule-in-nodule” sign; twelve （15.8%） more lesions showed posterior acoustic enhancement. Post-contrast ultrasound showed increased diagnostic accuracy of 93.4% （71/76）, compare with 88.2% （67/76） of CEUS alone. Conclusions High-MI post-contrast ultrasound utilizes harmonic signals during the rupture of microbubbles, and significantly improves the display of echo-characteristics of HCCs in ultrasound images, which adds diagnostic values for CEUS. Post-contrast ultrasound could play an important role in tissue characterization, and may be included in CEUS protocols.     

钆贝葡胺MRI增强在肝硬化结节与小肝癌诊断鉴别中的应用

目的探究钆贝葡胺(莫迪司)磁共振(MRI)增强在肝硬化结节与小肝细胞癌(HCC)诊断鉴别中的应用效果。方法回顾性分析我院86例经病理检查确诊为肝硬化合并肝内结节患者临床资料。记录86例患者病理检查结果,比较小HCC与肝硬化结节MRI增强扫描信号强度、医师对MRI增强动态三期及动态四期的诊断信心评分差异,并分析MRI增强动态三期及动态四期对小HCC和肝硬化结节的诊断准确性。结果86例患者共91个结节,其中小HCC65个(71.43%),肝硬化结节21个(23.08%),胆管细胞癌2个(2.20%),局灶性结节增生2个(2.20%),腺瘤1个(1.10%)。小HCC与肝硬化结节在动脉期、门静脉期、延迟期及肝胆期信号强度比较,差异均有统计学意义(P<0.05)。医师对MRI增强动态三期诊断信心评分明显低于动态四期诊断信心评分(P<0.05)。MRI增强动态三期对小HCC及肝硬化结节诊断准确率均低于动态四期(P<0.05)。结论钆贝葡胺MRI动态增强扫描在肝硬化结节和小HCC鉴别诊断中应用效果显著,能在提升医师诊断信心的同时,提高诊断准确性,临床使用价值较高。     

超声造影对肝癌射频消融筛选适应证的应用价值

目的通过射频消融前超声造影观察肿瘤大小、数目及分布,探讨其对筛选适应证的应用价值.方法北京大学临床肿瘤学院超声科就诊的164例确诊肝细胞癌（hepatocellular carcinoma,HCC）并符合经皮射频消融（radiofrequency Ablation,RFA）入选标准患者,随机分为两组进行对照研究.81例射频消融前采用SonoVue行超声造影（contrast-enhanced ultrasound,CEUS）检查（CEUS组）,83例射频消融前未行超声造影检查（对照组）.男121例、女43例;年龄38～72岁,平均52.4岁.造影前两组病例的临床资料差异无统计学意义.肿瘤平均直径超声造影组3.6 cm,对照组3.5 cm.治疗后采用常规超声,增强CT和/或超声造影等影像检查进行规律性随访.结果超声造影组81例造影后9例（11.1%）因发现肿瘤数目 〉5个 （5例）、范围测量〉8 cm（2例）、侵及2支大血管或肠管（2例）被确定为非射频消融适应证,余72例101灶行射频消融治疗.其中超声造影新发现≤1.7 cm 8例12灶中,5例为肝硬化及肝细胞癌治疗后随访病例,3例7个灶为肝细胞癌卫星灶.另有16灶为常规超声不能定性或误诊良性,经超声造影确认并指导射频消融治疗.两组随访6～36个月,超声造影组与对照组消融成功率分别为95.0%和89.6%（P〉0.05）.对照组新生率高于超声造影组（22.9% vs 9.7%,P〈0.05）.结论射频消融前超声造影有助于筛选适应证,显著减少新生转移病例.造影所获信息为早期检出微小癌灶提供了手段和依据,从而有效的提高射频消融对肝癌的治疗水平.     

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.