Unusual benign focal liver lesions: findings on real-time contrast-enhanced sonography.

OBJECTIVE: This presentation aims to provide an overview of the manifestations of some unusual benign focal liver lesions (FLLs) on low-acoustic power contrast-enhanced sonography (CES) with a sulfur hexafluoride contrast agent. METHODS: The patients were selected retrospectively from 2209 cases with FLLs who had undergone CES examinations for characterization during the past 3 years. The pathologic examinations proved that they were intrahepatic biliary cystadenoma (n = 1), angiomyolipoma (AML; n = 4), lipoma (n = 1), biliary epithelial dysplasia (n = 1), a fungal inflammatory mass (n = 1), tuberculoma (n = 2), an inflammatory pseudotumor (n = 7), sarcoidosis (n = 1), solitary necrotic nodules (n = 2), peliosis hepatis (n = 2), and focal fibrosis after surgery (n = 4). RESULTS: Contrast-enhanced sonography was beneficial in leading to a diagnosis of benignity for some lesions showing hyperenhancement during the arterial phase and sustained enhancement during the portal or late phase, such as liver AML and lipoma. The benign nature of other lesions showing no enhancement during all phases, such as solitary necrotic nodules and focal fibrosis, was also suggestible. On the other hand, for those lesions showing hyperenhancement, isoenhancement, or hypoenhancement during the arterial phase and hypoenhancement during the late phase, including intrahepatic biliary cystadenoma, biliary epithelial dysplasia, infected liver diseases, the inflammatory pseudotumor, sarcoidosis, and peliosis hepatis, the differential diagnosis between benignity and malignancy was difficult, and pathologic tests were mandatory. CONCLUSIONS: The CES features of unusual benign FLLs may enrich knowledge when performing CES examinations for characterization and may provide clues for a specific diagnosis of an individual lesion such as liver AML.     

肝内胆管细胞癌超声造影增强模式探讨

目的分析肝内胆管细胞癌（ICC）的超声造影增强模式,探讨其诊断价值。方法38例ICC患者,共38个病灶,注射超声造影剂SonoVue后分析病灶增强水平与增强方式。结果ICC病灶直径1．7-9．6cm,平均（5．6±2．2）cm。动脉相增强模式：均匀高增强5个,不均匀高增强10个,均匀低增强1个,不均匀低增强13个,环状增强6个,部分增强2个,均匀等增强1个。门脉相：低增强36个,等增强2个。延迟相：38个均表现低增强。14个病灶在注射造影剂45s内开始消退,22个在45～120S消退,2个在120S后消退。结论ICC超声造影表现为动脉相多种增强模式,与病灶大小有一定相关性。     

实时超声造影鉴别诊断肝脏瘤样病变

目的应用CEUS评价肝脏瘤样病变的血流灌注特征。方法选择35例瘤样病变患者(41个病灶)作为研究对象,21例经手术证实,14例经增强CT/MRI或随访证实。结果肝局灶性结节增生(FNH)13例,动脉相100%(13/13)高增强,动脉相早期10例呈中心向周边轮辐样强化,3例为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;门脉相100%(13/13)呈均匀高增强,延迟相84.62%(11/13)等或高增强,15.38(2/13)中心部低增强。肝孤立性坏死结节(SNN)12例,三相均未见强化,病灶大小、数目不一,形态各异。肝炎性假瘤(IPL)4例,动脉相高增强,门脉相低增强。肝局灶性脂肪变(FFC)6例,动脉相33.33%(2/6)高增强,16.67%(1/6)低增强,50.00%(3/6)等增强,门脉相及延迟相呈等增强。结论肝FNH、SNN和FFC的CEUS具有特异性表现,而IPL需与原发性肝细胞癌相鉴别。     

Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions.

OBJECTIVE: The purpose of this study was to investigate the features of infected focal liver lesions on contrast-enhanced ultrasound (CEUS) imaging. METHODS: Thirty-two hepatic abscesses, 15 infected granulomas, and 6 inflammatory pseudotumors in 53 patients were evaluated with real-time CEUS before awareness of the definitive diagnosis. A 2.4-mL dose of a sulfur hexafluoride-filled microbubble contrast agent was administered by intravenous bolus injection. RESULTS: The numbers of abscesses with hyperenhancement, isoenhancement, and hypoenhancement in the arterial phase were 26 (81.3%), 5 (15.6%), and 1 (3.1%), respectively. Thirty (93.8%) lesions were irregularly rim enhanced with nonenhanced areas; enhanced septa were shown in 22 (68.8%) lesions; and transient hyperenhancement of liver parenchyma around the lesion was shown in 20 (62.5%). In 31 abscesses with hyperenhancement or isoenhancement in the arterial phase, 25 (80.6%) showed contrast wash-out and changed in appearance to hypoenhancement in the late phase. As for infected granulomas and inflammatory pseudotumors, 16 (76.2%) lesions showed hyperenhancement or isoenhancement in the arterial phase, and all of them were hypoenhanced in the portal and late phases. CONCLUSIONS: Most infected focal liver lesions showed more rapid contrast wash-out than the surrounding liver parenchyma, which is similar to malignant lesions. Abscesses typically showed features of rim enhancement, enhanced internal septa, nonenhanced central necrotic areas, and transient hyperenhanced liver parenchyma around the lesions. The CEUS appearance of infected granulomas and inflammatory pseudotumors was variable, and a biopsy was necessary for definitive diagnosis.     

肝内胆管细胞癌超声造影与增强MRI表现对比分析

目的 分析肝内胆管细胞癌超声造影与增强MRI影像学表现特点.方法 8例经手术病理证实的肝内胆管细胞癌,术前行超声造影、增强MRI检查.结果 超声造影：动脉期5例周边环状高增强,1例整体均匀高增强,2例整体不均匀高增强;门脉期6例整体为低增强,2例内部呈低增强,周边仍见环状高增强;延迟期均呈低增强.增强MRI：动脉期8例环状高增强;门脉期及延迟期1例环状高增强,7例向心性增强.结论 肝内胆管细胞癌超声造影与增强MRI表现不同,可能与疾病的病理特点及两种造影剂在人体内的分布特点有关.     

Imaging of peripheral cholangiocarcinoma with low-mechanical index contrast-enhanced sonography and SonoVue: initial experience.

OBJECTIVE: The purpose of this study was to investigate the imaging findings of peripheral cholangiocarcinoma with low-mechanical index (MI) contrast-enhanced sonography. METHODS: Eighteen nodules of peripheral cholangiocarcinoma proved by pathologic examination in 18 patients were evaluated with contrast-enhanced sonography. A low-MI real-time contrast-enhanced sonographic mode (ie, contrast pulse sequencing) and a sulfur hexafluoride-filled microbubble contrast agent (SonoVue [BR1]; Bracco SpA, Milan, Italy) were used. RESULTS: On contrast-enhanced sonographic images, all 18 nodules (100%) of peripheral cholangiocarcinoma showed inhomogeneous enhancement during the arterial phase, and the emergence of nodule enhancement was earlier in 3 nodules (16.7%), simultaneous in 13 (72.2%), and later in 2 (11.1%), respectively, when compared with the adjacent liver tissue. During the arterial phase, 8 nodules (44.4%) showed irregular peripheral rimlike hyperenhancement, 2 (11.1%) showed inhomogeneous hyperenhancement, and 8 (44.4%) showed inhomogeneous hypoenhancement. In portal and late phases, all 18 nodules (100%) showed hypoenhancement. When contrast-enhanced sonography was added for analysis, the confidence levels of the investigators were improved in 15 (83.3%) of 18 nodules, and 17 (94.4%) of 18 peripheral cholangiocarcinomas were correctly characterized. CONCLUSIONS: The imaging findings of peripheral cholangiocarcinoma had some characteristics on low-MI contrast-enhanced sonography. Knowledge of these characteristics might be beneficial for improving the diagnostic performance of sonography in evaluating this entity.     

The analysis of enhancement pattern of hepatic inflammatory pseudotumor on contrast-enhanced ultrasound

Objective

The aim of this study was to assess the role of contrast-enhanced ultrasound (CEUS) in the characterization of hepatic inflammatory pseudotumor (IPT).

Methods

We retrospectively reviewed 36 cases of histopathologically diagnosed IPT. Nodule enhancement appearances during the arterial, portal, and delayed phases were defined as hyperenhancement, isoenhancement, hypoenhancement, and non-enhancement compared with the surrounding liver parenchyma. Statistical analysis was performed by the one-way ANOVA and χ ² tests.

Results

Among total 36 cases, 7 nodules were absent of contrast enhancement during all three phrases on CEUS. Twenty-nine nodules appeared different forms of enhancement in arterial phase. Diffuse homogeneous hyperenhancement, diffuse heterogeneous hyperenhancement, peripheral rim-like enhancement, and diffuse iso-enhancement were found in 10, 12, 5, and 2 of the nodules, respectively. Twenty-five nodules showed hypoenhancement in portal and delayed phases. Four nodules showed contrast washed out synchronously with normal liver parenchyma. The median time to enhancement, median time to peak, and median time to wash out of the nodules were 17 s (range 11–28 s), 23 s (range 14–42 s), and 45 s (range 23–100 s), respectively. No statistical significant differences were found in the above parameters of nodule enhancement and proportion of enhancement patterns when dividing the nodules into subgroups by nodule size.

Conclusion

IPT displays a variety of enhancement patterns due to pathological changes in the course of disease progression. Some characteristics on CEUS may be helpful in the differential diagnosis of IPT.     

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.     

Role of Contrast‐Enhanced Ultrasonography in Primary Hepatic Lymphoma

Objective. Ultrasonography is the first examination performed for screening of hepatocellular carcinoma (HCC); contrast‐enhanced ultrasonography (CEUS) can help discriminate between HCC and other lesions. Primary hepatic lymphoma (PHL), even if rare, should be considered in the differential diagnosis of focal liver lesions (FLLs). Few data are available in the literature about the role of CEUS in the diagnosis of PHL; we tried to determine whether CEUS could have a role in this setting. Methods. we describe 2 cases of primary non‐Hodgkin lymphoma of the liver associated with hepatitis B virus (HBV) infection. The first patient was a 62‐year‐old man who was an HBV‐inactive carrier, and the second was a 58‐year‐old man with type 2 diabetes and chronic HBV hepatitis. Results. in both cases, ultrasonography showed a hypoechoic liver lesion (4 and 3 cm, respectively) with irregular margins in segment 4 of the liver. On CEUS, these lesions were inhomogeneously hyperenhanced in the arterial phase and hypoenhanced in the portal and late phases. Contrast‐enhanced computed tomography (CT) in both patients showed slight hyperenhancement in the arterial phase and hypoenhancement in the remaining phases. Needle biopsy showed marginal zone B‐cell lymphoma of the mucosa‐associated lymphoid tissue type in both patients. Conclusions. Contrast‐enhanced ultrasonography and CT did not help us differentiate PHL from HCC; in fact, in both cases we saw the characteristic findings of primary HCC. Primary hepatic lymphoma is a rare condition, but it should always be considered in the differential diagnosis of FLLs. We stress the important role of liver biopsy when imaging indicates HCC in patients without underlying cirrhosis.     

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.     

超声造影在肝硬化增生结节病变中的应用

目的 观察肝硬化背景下局灶性病变超声造影表现,分析增生癌变的增强特征及与肝细胞癌(HCC)、再生结节的鉴别.方法 141例经临床及影像学诊断为肝硬化患者超声检查发现163个直径1～3 cm局灶性病变,均行超声造影检查.之后采用18G粗针穿刺活检,特别对同一结节内的不同增强区域分别取材.结果 最终确诊增生癌变21个,HCC 45个,再生结节97个.21个增生癌变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,结节其余部分与肝同步增强或延迟增强,少数23.8%(5/21)延迟期较肝提前退出.HCC 45个病灶中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.再生结节97个病灶中96.9%(94/97)动脉期与肝同步或延迟增强,3.1%(3/97)轻度增强,至延迟期25.8%(25/97)退出,74.2%(72/97)与肝同步.21个增生癌变穿刺活检组织病理学证实动脉期增强区域为癌变区域,而动脉期与肝同步或延迟增强区域为肝细胞增生.结论 超声造影可敏感反映肝硬化背景下局灶性病变的不同病理组织学特征,重视超声造影增强区域取材活检可提高确诊率及肝癌的早期诊断.     

转移性小肝癌超声造影表现特征

目的探讨转移性小肝癌的超声造影表现特征。 方法回顾性分析复旦大学附属中山医院94个转移性小肝癌病灶及150个小肝细胞癌（HCC）病灶的超声造影图像,对比2组病灶超声造影的增强方式和时相变化（增强时间、达峰时间、等回声时间、低回声时间）。 结果94个转移性小肝癌病灶中,66.0%（62/94）表现为整体增强,34.0%（32/94）表现为环状增强;150个小HCC病灶中,98.7%（148/150）表现为整体增强,1.3%（2/150）表现为环状增强,转移性小肝癌动脉期环状增强的比例显著高于小HCC（P<0.01）。转移性小肝癌的超声造影等回声时间、低回声时间、从等回声至低回声所经历的时间分别为（28.7±6.3）s、（39.1±16.2）s、（8.2±8.5）s;小HCC的超声造影等回声时间、低回声时间、从等回声至低回声所经历的时间分别为（35.8±12.5）s、（86.8±45.5）s、（52.5±44.2）s,转移性小肝癌的超声造影等回声时间、低回声时间及从等回声至低回声所经历的时间均短于小HCC（t=-8.722、-12.636、-10.571,P值均<0.01）。 结论整体增强和环状增强均为转移性小肝癌的常见表现,增强方式和减退时间有助于转移性小肝癌和小HCC的鉴别,超声造影有助于转移性小肝癌的诊断。     

周围型肝内胆管细胞癌:超声造影与增强CT对照

目的 比较周围型肝内胆管细胞癌(ICC)的CEUS与增强CT特点。方法 回顾性分析经手术及病理证实的30例ICC患者(36个病灶)的CEUS及增强CT表现,采用Kappa一致性检验评估两种检查方法诊断的准确率。结果 CEUS显示36个病灶均为动脉期增强,门静脉期及延迟期回声减弱,呈"快进快出"型。增强CT动脉期图像示36个病灶均强化,28个门静脉期及延迟期持续强化,另8个门静脉期及延迟期强化程度减退。CEUS显示19个病灶(19/36,52.78%)周边部环状增强,17个(17/36,47.22%)整体增强;21个(21/36,58.33%)表现为"树枝样"向内延伸。增强CT显示22个病灶(22/36,61.11%)周边环状强化,其中5个呈分隔样强化;14个(14/36,38.89%)为整体强化。达峰值时,CEUS示23个病灶不均匀增强,13个均匀增强;增强CT示20个病灶不均匀增强,16个均匀增强。以"快进快出"、环状增强和(或)"树枝样"增强作为CEUS诊断ICC的标准,CEUS的诊断准确率为70.00%(21/30);以动脉期"环状强化",门静脉期及延迟期"持续强化"作为CT诊断ICC的标准,增强CT的诊断准确率为73.33%(22/30);Kappa一致性检验显示两种检查方法具有很好的一致性(Kappa值＝0.824)。结论 周围型ICC的CEUS与增强CT表现具有一定特征性;两种方法对于周围型ICC均有较高诊断价值。     

The current status of contrast-enhanced ultrasound in China

This review article provides an overview of the use of contrast-enhanced ultrasound (CEUS) in China. Currently, the only licensed contrast agent is SonoVue, a sulfur hexafluoride-filled microbubble contrast agent. In combination with a low mechanical index contrast-specific imaging mode, SonoVue-enhanced CEUS can be used to visualize the micro and macro-vasculature continuously. Since 2004, CEUS has been widely used in China in various clinical scenarios. The authors compared CEUS with baseline ultrasound or contrast-enhanced computed tomography with regard to characterization of focal liver lesions (FLLs). On CEUS, heterogeneous or homogeneous hyperenhancement during the arterial phase and washout in the portal/late phase are typical findings for hepatocellular carcinoma. The enhancement features of intrahepatic cholangiocarcinoma, infected FLLs, focal fatty infiltration, focal fatty sparing, complex cystic FLLs, and uncommon benign FLLs were carefully depicted. CEUS was also used for patient selection in ablation therapy and evaluation of response to ablation for liver cancer. The utility of three-dimensional CEUS of the liver was also explored. In non-liver use, CEUS in hilar cholangiocarcinoma, gallbladder, breast, and prostate was initially investigated. In addition, CEUS was used in interventional procedures such as CEUS-guided hemostatic injection, intraoperative CEUS in neurosurgery, and evaluation of response to high-intensity focused ultrasound ablation of uterine fibroids. The Chinese experience has resulted in increased use of CEUS.     

Contrast-Enhanced Ultrasound Features of Histopathologically Proven Hepatocellular Carcinoma in the Non-cirrhotic Liver: A Multicenter Study

Current literature on the role of contrast-enhanced ultrasound (CEUS) in the diagnosis of hepatocellular carcinoma (HCC) in non-cirrhotic patients is limited. The aim of this retrospective multicenter study was to analyze CEUS features of histologically proven HCC in patients with non-cirrhotic liver. In this multicenter study, 96 patients from eight medical institutions with histologically proven HCC lesions in non-cirrhotic liver were retrospectively reviewed regarding SonoVue-enhanced CEUS features. Two ultrasound experts assessed the CEUS enhancement pattern and came to a consensus using the World Federation of Societies for Ultrasound in Medicine and Biology guideline criteria. The mean size of HCC lesions included was 60.3 ± 37.8 mm (mean ± standard deviation). Most of the lesions were heterogeneous but predominantly hypo-echoic on B-mode ultrasound (64.5%, 62/96), with ill-defined margins and irregular shapes. During the arterial phase of CEUS, most of the HCC lesions in non-cirrhotic liver exhibited heterogeneous hyperenhancement (78.1%, 75/96) compared with the surrounding liver parenchyma. Almost 30% of HCC lesions (28.1%, 27/96) exhibited early wash-out (<60 s). All lesions exhibited wash-out and hypo-enhancement in the late phase. CEUS features of HCC lesions in non-cirrhotic patients typically include hyperenhancement in the arterial phase and relatively rapid wash-out in the portal venous phase, which is different from HCC in cirrhotic livers and more similar to liver metastasis.     

超声造影对高强度聚焦超声联合肝动脉栓塞化疗治疗肝癌的疗效评价

目的探讨超声造影(CEUS)评价高强度聚焦超声(HIFU)联合肝动脉栓塞化疗(TAE)治疗肝恶性肿瘤疗效的应用价值。方法 24例肝癌患者,其中原发性肝癌15例,转移癌9例,治疗病灶总计31个,TAE治疗后1周内行HIFU治疗,于治疗前和治疗后7～14 d行CEUS检查,并与同期彩色多普勒超声(CDFI)、增强MRI检查结果比较。结果 CEUS观察31个病灶治疗覆盖区,19个(61.3%)在各期均为无增强,提示肿瘤完全灭活,12个(38.7%)病灶边缘或中央局部动脉期高增强,门脉期或延迟期减退为低增强,提示为肿瘤残存。以最终诊断为金标准,CEUS诊断准确性90.3%,增强MRI为93.5%,彩色多普勒超声为48.4%。CEUS与增强MRI在评价肿瘤灭活方面的敏感性、特异性、准确性差异均无统计学意义(P>0.05),CEUS对肿瘤灭活诊断的准确性高于CDFI(P<0.05)。结论 CEUS可较准确地判断HIFU联合TAE治疗后肿瘤灭活程度,可为肝癌治疗近期疗效评价提供依据,有较高临床应用价值。     

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。     

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%.     

肝硬化结节的CEUS表现及其临床意义

目的分析肝硬化结节CEUS表现及其转归,探讨CEUS对肝硬化结节的诊断价值。方法应用实时灰阶CEUS技术观察63例患者共113个肝硬化结节。结果 113个肝硬化结节CEUS表现分为8种:①三相一致,73个病灶(73/113,64.60%);②缺损-一致,20个病灶(20/113,17.70%);③快进快出,4个病灶,(4/113,3.54%);④快进慢出,4个病灶(4/113,3.54%);⑤一致-快出,4个病灶(4/113,3.54%);⑥缺损-快出,4个病灶(4/113,3.54%);⑦低增强慢出,2个病灶(2/113,1.77%);⑧三相缺损,2个病灶(2/113,1.77%)。CEUS随访中8个病灶声像图发生变化,最终3个转变为恶性。结论 CEUS表现为"三相一致"的肝硬化结节预后较其他型相对安全;CEUS表现为动脉相"缺损"或晚期相"快出"的肝硬化结节相对较不稳定,需引起高度重视;少数肝硬化结节CEUS表现为类恶性,是导致CEUS出现假阳性的主要原因。     

肝内胆管癌超声造影的增强特点

目的 探讨肝内胆管癌（ICC）超声造影的增强特点。 方法 13例ICC患者共13个病灶接受了超声造影检查（CEUS）。CEUS采用造影剂Sono Vue和低机械指数成像技术对比脉冲序列（CPS）。 结果 动脉期13个（100％）病灶呈不均匀增强。9个（69．2％）病灶为低增强，其中7个在周边见高回声的不规则环状增强。另外4个（30．8％）在动脉期显示为高（n=1）或等增强（n=3）。门静脉期全部病灶呈不均匀低增强，其中6个（46．2％）病灶低增强范围有所扩大。至延迟期全部病灶呈均匀低增强。 结论 ICC在CEUS各时相的增强模式具有特征性，对ICC的定性诊断可提供帮助。