肝局灶性结节增生及肝血管瘤的超声鉴别诊断

目的:研究二维及三维超声在肝局灶性结节增生(FNH)及肝血管瘤(HCH)鉴别诊断中的作用.方法:选择经手术病理证实、肝组织病理活检或增强CT/MRI证实肝内病变57例共72个病灶:其中肝局灶性结节增生13例13个病灶,肝血管瘤44例59个病灶,行二维及三维超声检查.分别记录灰阶图像特点、彩色多普勒特点及PSV、RI、VI.结果:典型的FNH及HCH二维图像有特征性的改变,血流速度FNH组高于HCH组,三维超声的血流指数FNH组高于HCH组.结论:三维超声可以定量研究病变的血流指数,FNH及HCH的血流指数特点在协助二维及彩色多普勒超声鉴别诊断方面有一定的作用,二维和三维相结合可以更好地鉴别诊断FNH及HCH.     

SENSE基础上扩散加权成像诊断肝脏占位性病变的价值

目的探讨SENSE基础上扩散加权成像在诊断肝占位性病变中的应用价值以及表面扩散系数(ADC)评估肝占位病变的价值。方法对161例共有224个肝占位病灶患者在SENSE基础上行扩散加权成像。224个肝占位病灶中原发性肝癌80个,肝血管瘤45个,肝囊肿49个,转移性肝癌50个。应用梯度因子b值为0和50的扩散图像,并获取ADC值。结果原发性肝癌、肝血管瘤、肝囊肿和转移性肝癌的平均ADC值分别为(0.99±0.33)×10-3mm2/s、(1.99±0.30)×10-3mm2/s、(3.80±0.37)×10-3mm2/s和(1.08±0.29)×10-3mm2/s,前三者差异有极显著性意义(P<0.01)。原发性肝癌和转移性肝癌之间差异无显著性意义(P>0.05)。结论SENSE基础上扩散加权平面回波成像对肝癌(包括原发性肝癌和转移性肝癌)、肝血管瘤和肝囊肿的鉴别诊断具有较高的价值。     

SENSE基础上扩散加权成像诊断肝脏占位性病变的价值

【摘要】目的：探讨SENSE基础上扩散加权成像在诊断肝占位性病变中的应用价值以及表面扩散系数(ADC)评估肝占位病变的价值。方法：对161例共有224个肝占位病灶患者在SENSE基础上行扩散加权成像。224个肝占位病灶中原发性肝癌80个,肝血管瘤45个,肝囊肿49个,转移性肝癌50个。应用梯度因子b值为0和50的扩散图像,并获取ADC值。结果：原发性肝癌、肝血管瘤、肝囊肿和转移性肝癌的平均ADC值分别为(0.99±0.33)×10-3mm2/s、(1.99±0.30)×10-3mm2/s、(3.80±0.37)×10-3mm2/s和(1.08±0.29)×10-3mm2/s,前三者差异有极显著性意义(P<0.01)。原发性肝癌和转移性肝癌之间差异无显著性意义(P>0.05)。结论：SENSE基础上扩散加权平面回波成像对肝癌(包括原发性肝癌和转移性肝癌)、肝血管瘤和肝囊肿的鉴别诊断具有较高的价值。     

实时三维超声对膀胱占位性病变的诊断价值

目的 :探讨实时三维超声对膀胱占位性病变的诊断价值,提高对膀胱占位性病变的检出率。方法 :对56例膀胱占位性病变患者行二维超声及二维联合实时三维超声扫查,对比2种方法对膀胱占位性病变的显示率。结果:56例膀胱占位性病变共65个病灶,二维超声检查共发现52个病灶,漏诊13个,准确率为80%;二维超声联合实时三维超声发现65个病灶,准确率为100%。2种检查方式检出准确率比较差异有统计学意义(P0.05)。结论 :二维超声联合实时三维超声可以明显提高膀胱占位性病变的诊断准确性。     

超声造影与彩色多普勒诊断肝肿瘤的临床应用

目的比较实时超声造影和彩色多普勒超声在肝肿瘤诊断中的临床应用价值。方法应用超声造影技术及彩色多普勒超声对常规二维超声难以定性的30例患者31个肝占位灶进行检查,并与病理结果相对照。结果31个病灶中肝恶性肿瘤24个,肝血管瘤3个,肝硬化增生结节1个,肝脓肿2个,肝包虫1个。除1例肝包虫外,其余30个病灶超声造影均在不同时相出现不同程度强化现象。彩色多普勒超声在病灶内部或周边能检测到动脉血流频谱者共19例20个病灶;以增强早期呈高回声而增强晚期呈低回声为恶性肿块的诊断标准,则超声造影对肝癌诊断的准确性为93%;以病灶内部检测到动脉样血流频谱为诊断恶性肿块的诊断标准,则彩色多普勒超声诊断肝恶性肿瘤的准确性为74%,二者差别有统计学意义(P<0.05)。结论实时超声造影能提高肝肿瘤诊断的准确性,对肝肿瘤良、恶性的诊断及鉴别诊断具有重要的临床应用价值。     

小肝癌的碘油CT研究

目的：探讨碘油CT对小肝癌诊断及鉴别诊断和临床应用价值。材料和方法：临床诊断肝癌或肝癌术后复发、超声，平扫及增强CT检查肝内病灶最大径≤3cm患者56例。经股动脉插管肝动脉造影后注入碘油4～12ml．1—4周后作CT扫描．根据CT检查结果作出前瞻性诊断并和手术病理结果对照。结果：56例共发现131个病灶。其中肝癌病灶109个，血管瘤12个．其它10个。在109个小肝癌病灶中四种影像方法检出率分别为超声70．6%，CT61．5%，血管造影61．5%，碘油CT85．3%。诊断特异性分别为68．8%．83.5?．1%和92．5%．碘油CT均明显为优．结论 本研究显示碘油CT是目前诊断小肝癌最敏感和准确的影像方法之一。     

超声造影在脂肪肝背景下肝低回声结节鉴别诊断中的应用

目的探讨实时超声造影对脂肪肝背景下肝内低回声结节的诊断价值。资料与方法应用超声造影对常规灰阶超声不能明确诊断的44例脂肪肝背景下54个低回声结节的增强模式进行分析,并与超声引导下穿刺活检以及手术病理诊断等最终诊断结果进行比较。结果 44例脂肪肝患者的54个低回声病灶中,超声造影诊断原发性肝癌15个,转移性肝癌7个,肝血管瘤14个,肝脓肿3个,肝囊肿1个,肝腺瘤1个,肝局灶性脂肪缺失11个,另外有1个肝腺瘤误诊为血管瘤,1个肝血管瘤超声造影不能明确诊断。超声造影的诊断符合率为96.3%,明显优于常规超声的51.9%。结论超声造影可以提高脂肪肝背景下肝低回声结节的诊断准确率,是鉴别诊断脂肪肝背景下肝低回声结节的有效方法。     

超声造影与彩色多普勒超声诊断肝实质性肿块对照研究

 目的 比较彩色多普勒超声和实时超声造影对肝实质性肿块的诊断价值.方法 应用彩色多普勒超声及超声造影技术对常规二维超声难以定性的27例共31个肝实质性肿块进行检查,结果与手术及病理结果相对照.结果 31个肿块中原发性肝细胞性肝癌24个,肝血管瘤3个,肝脏局灶性结节增生3个,肝孤立性坏死结节1个.彩色多普勒超声在肿块内部或肿块周边能检测到动脉血流频谱者共19例21个肿块;超声造影除一例肝孤立性坏死结节外,其余30个病灶均在不同时相出现不同程度强化现象.如以动脉相呈高回声而门脉相及延迟相呈低回声为恶性肿块的诊断标准,则超声造影对肝癌诊断的准确率为91.67%;如以肿块内部检测到动脉样血流频谱为诊断恶性肿块的诊断标准,则彩色多谱勒超声诊断肝癌的准确率为75%.超声造影诊断肝实质性肿块准确率为93.54%,彩色多普勒超声诊断肝实质性肿块准确率为64.52%.二者差别有统计学意义(P＜0.05).结论 实时超声造影显著提高肝内实质性肿块的诊断准确性,对肝脏实质性肿块良、恶性的诊断及鉴别诊断具有重要价值.     

造影剂Sono Vue和对比脉冲序列成像技术诊断肝脏局灶性病变的价值

目的探讨新型造影剂SonoVue和对比脉冲序列(CPS)成像技术对肝脏局灶性病变(FLL)的诊断价值.材料和方法对126例(142个病灶)FLL患者进行超声造影检查,103例经手术或穿刺病理证实,余23例经CT、MRI增强检查和临床综合资料证实(肝细胞性肝癌63个,肝内胆管细胞癌5个,转移性肝癌15个,肝血管瘤28个,肝局灶性结节性增生10个,肝炎性假瘤3个,肝腺瘤3个,局灶性脂肪肝7个,肝硬化结节8个).结果恶性组与良性组相比达峰时间、消退时间提前,持续时间缩短(P＜0.05);原发性肝癌比转移性肝癌消退时间提前(P＜0.05).在动脉相,41个(65%)中低分化肝细胞性肝癌(Hcc)病灶呈高增强,3个(5%)高分化HCC病灶在所有时相均呈等增强;3个肝内胆管细胞癌和8个转移性肝癌病灶在动脉相呈环状增强.18个(18/28)血管瘤在动脉相,呈周边结节状增强,门脉相呈向心性填充;6个(6/10)肝局灶性结节性增生动脉相呈轮辐状增强;2个肝腺瘤动脉相呈高增强;2个炎性假瘤于3个时相均未见增强.所有的局灶性脂肪肝和肝硬化结节在3个时相呈等增强.结论超声造影是鉴别FLL的一种很有前途的影像手段,极大地提高了超声对FLL的诊断价值.     

超声造影对移植肝脏局灶性病变的诊断价值

目的：评价超声造影对移植肝脏局灶性病变的诊断价值。方法：对30例移植肝脏局灶性病变患者,用西门子Sequoia 512彩色多普勒超声诊断仪和超声对比剂Sonovue进行超声造影检查,观察三个时相的对比剂灌注模式,并用自动跟踪对比量化技术（Axius ACQ）对病灶及周围肝组织进行定量分析。所有病例均经病理及临床随访证实。结果：30例移植肝脏局灶性病变患者,超声造影正确诊断29例,包括肝癌复发18例、非均质脂肪肝5例、肝血管瘤4例、梗死灶2例;超声造影误诊1例,超声造影怀疑肝癌复发,经穿刺活检诊断为局灶性脂肪浸润。结论：移植肝脏局灶性病变具有各自典型的增强模式,超声造影技术有助于移植肝脏局灶性病变的鉴别诊断,具有重要临床价值。     

Ultrasonography of small hepatic tumors

The differential accuracy of ultrasonographic examinations of small hepatic tumours was analyzed by receiver-operating characteristics. Using only one image of a single hepatic tumor under 3 cm in diameter as revealed by real-time scanner, the readers were requested to select one out of five diagnoses (hepatocellular carcinoma, metastatic tumor, cavernous hemangioma, cyst, or miscellaneous) and to choose the credibility from five levels of confidence. The averaged diagnostic accuracy was 68% in hepatocellular carcinoma, 70% in metastatic tumor, and 77% in cavernous hemangioma. Hepatic tumors were classified retrospectively into eight ultrasonographic patterns, based on mutual consent. The mosaic and hypoechoic patterns were relatively characteristic of hepatocellular carcinoma (91% and 92% respectively). Except for these two patterns, ultrasonographic findings in small liver tumors were nonspecific, including frequently reported hyperechoic pattern for cavernous hemangioma.     

乏血供小肝癌1例

患者男,59岁。腹痛、腹胀1月余,加重1周来我院就诊。查体:皮肤无黄染,腹平软,轻度压痛,肝肋下未触及,未见肠形和胃肠蠕动波,未见腹壁静脉曲张,腹水征(-)。AFP升高。B超所见:肝脏左叶外侧段见一稍高回声区,大小约3·6cm×3·2cm,境界清晰,具淡声晕,边缘锐利,后方回声稍衰减。CT扫描:平扫示肝左叶外侧段一略低密度影,边缘不清,外侧段略向肝外突出,大小约为3·6cm×3·2cm,CT值约为40HU,内见多个小点片样更低密度影(图1),增强扫描动脉期:病灶边缘略强化,强化程度等同于肝脏密度,中部见片样无强化区(图2);门静脉期:边缘强化区低于肝实质,中…     

肝门小胆管癌的多层CT分析

目的:探讨肝门小胆管癌的多层CT影像表现和诊断价值。方法:收集13例经手术及病理证实的直径小于2cm的肝门胆管癌,回顾性分析其多层CT表现。结果:13例病灶CT:平扫均为等密度。增强扫描动脉期10例病灶呈中等强化,3例未见强化;门脉期13例病灶均表现为中等强化,其中见8例肿瘤邻近层面的胆管壁呈不规则的环形强化,其厚度均超过2mm。结论:多层CT对诊断肝门小胆管癌有很大价值。     

超声造影在肝硬化及小肝癌诊断中的应用进展

本文介绍超声造影在肝硬化、小肝癌及肝癌病理分化的应用及其目前存在的问题。同时,综述国内外的最新研究成果,展现出超声造影是目前超声医学发展最快速的应用之一,它使超声医学步入一个崭新的领域。可作为CT等影像诊断的补充手段,有助于提高肝硬化背景下小肝癌的早期诊断率。     

肝小血管瘤与小肝癌的鉴别诊断:最新介绍的能谱CT的方法

目的研究动脉晚期和门静脉期,CT能谱成像参数在鉴别伴或不伴肝硬化的肝小血管瘤与小肝癌(≤3cm)中的应用价值。材料与方法这项前瞻性的研究得到了伦理委员会的批准,并且所有病人签署了知情同意书。49例病人(39例男性病人,10例女性病人;65个病灶部位)接受了动     

Hemodynamics of small hepatic focal nodular hyperplasia: evaluation with single-level dynamic CT during hepatic arteriography

OBJECTIVE: We examined the usefulness of single-level dynamic CT during hepatic arteriography to observe the hemodynamics of small hepatic focal nodular hyperplasia. CONCLUSION: Single-level dynamic CT during hepatic arteriography revealed not only centrifugal blood supply through the fibrous stellate scar, but also the drainage to dilated veins in or near the focal nodular hyperplasia nodule and directly to the hepatic sinusoid in the surrounding liver.     

Ultrasonography of small hepatic tumors using high-resolution linear-array real-time instruments

Abdominal ultrasonography using a high-resolution linear-array real-time scanner was compared to computed tomography, celiac arteriography, and radionuclide imaging in 24 patients with a total of 33 hepatocellular carcinomas (HCC), 10 patients with cavernous hemangioma (12 tumors), and 2 patients with metastatic carcinoma of the liver (3 tumors), all smaller than 3 cm. Ultrasound proved to be the most sensitive method of detecting such small tumors. Most small HCCs were hypoechoic and most small hemangiomas hyperechoic. Aspiration cytology and/or biopsy under ultrasound guidance detected 92.3% of HCCs and 100% of hemangiomas. Intraoperative ultrasound was employed in 19 cases of small HCC and aided resection in 8. Real-time ultrasound may play a prominent role in early detection and diagnosis of small HCCs.     

CT of small pyogenic hepatic abscesses: the cluster sign

Of 36 consecutive patients with pyogenic liver abscesses evaluated by CT, five (14%) had multiple small abscesses less than 2 cm in size. The CT appearance of the small pyogenic abscesses was compared with that of 10 patients who had either fungal or mycobacterial abscesses and with that of 50 patients who had hepatic metastases. In all five patients who had small pyogenic abscesses, the abscesses appeared to cluster, or aggregate, in a pattern that suggested the beginning of coalescence into a single, larger abscess cavity (cluster sign). This cluster appearance was not seen in in any of the patients who had fungal or mycobacterial microabscesses. It was present in only one of the patients who had confirmed hepatic metastasis. Despite the small size of the abscesses, guided needle aspiration was successful in recovering pyogenic organisms in four of the five patients. In our experience, the presence of the cluster sign suggests that the lesions are pyogenic abscesses.     

Infusion hepatic angiography in the detection of small hepatocellular carcinomas

Selective celiac angiography, conventional hepatic angiography, and infusion hepatic angiography, were utilized for the diagnosis of hepatocellular carcinoma in 90 patients. The first two of these methods were not always able to detect small foci measuring less than 2 cm in diameter, due to vascular proliferation which cannot be distinctly identified by conventional angiography. In these cases infusion hepatic angiography enhanced the detection of the foci. This method is indispensible in the diagnosis of hepatocellular carcinoma.