肝肿瘤动态灰阶超声造影和增强CT表现的比较研究

目的　比较动态灰阶超声造影和增强CT显示肝肿瘤血流信号的特点。方法　对 49例病理证实的肝内实质性占位病变 (原发性肝癌 2 8例 ,肝血管瘤 9例和肝局灶性结节增生 12例 )进行超声造影和增强CT检查 ,比较两种影像技术在注射造影剂后不同时相的增强表现。结果　超声造影显示原发性肝癌中 85.7% (2 4/ 2 8)的肿块增强早于肝实质 ,门脉相和延迟相则多呈低回声 ;与增强CT显示 84.0 %(2 1/ 2 5)的肿瘤动脉期高密度、门脉期多呈低密度相一致。血管瘤中 67.7% (6/ 9)在超声造影的动脉相无明显增强 ,尔后逐渐向内部填充 ;与CT显示的造影剂逐渐填充呈结节状强化极为相似。肝局灶性结节增生在超声造影和增强CT上均显示早期快速增强 ,而消退较慢。 3种肿瘤在超声造影和增强CT不同时相的增强情况比较差异无显著性意义 (χ2 检验 ,P >0 .0 5)。结论　动态灰阶超声造影和增强CT都能敏感地显示不同肝肿瘤的血供特征 ,为肝肿瘤的鉴别诊断提供依据     

超声造影在肝恶性肿瘤介入治疗疗效评估中的应用价值

目的观察肝恶性肿瘤介入治疗后超声造影表现,并与其他影像学方法比较,评估其对介入治疗疗效判定的临床应用价值。方法评估介入治疗疗效66例次,病灶78个,介入治疗后均行超声造影检查及同期CT/MRI/DSA检查(超声造影前后2周内),包括经肝动脉插管栓塞化疗(TACE)38例次46个病灶,射频(RF)消融治疗13例次15个病灶,经皮乙醇注射(PEI)治疗15例次17个病灶。超声造影显像将病灶分为有增强和无增强两类。结果介入治疗后,超声造影显示44个病灶(56.4%)动脉相局部增强区,34个病灶无增强。同期CT/MRI/DSA诊断41个病灶(52.6%)有肿瘤复发/残存,以后者为对照,实时谐波超声造影评估肝恶性肿瘤介入治疗疗效的敏感性为87.8%,特异性为78.4%,符合率为83.3%。TACE、RF、PEI三种肝脏恶性肿瘤治疗方式中,超声造影对TACE治疗后疗效评估的敏感性、特异性及符合率最高,分别为92.0%,85.7%,89.1%。结论超声造影可以作为肝脏恶性肿瘤介入治疗疗效评估的可靠方法,且更适于TA-CE治疗后的疗效评价。     

实时灰阶超声造影和螺旋CT诊断肝肿瘤的比较研究

目的比较实时超声造影和螺旋CT显示肝肿瘤血流信号的特点.方法对29例肝肿瘤(原发性肝癌16例,转移性肝癌2例,血管瘤6例和肝局灶性结节增生5例)分别进行超声造影和CT检查.结果超声造影显示肝恶性肿瘤的整体型、血管瘤的周边型及局灶性结节增生的中央型出现率显著高于其他病变(P<0.01).CT示恶性肿瘤中94.4%(17/18) 动脉期强化、门脉期低密度;血管瘤中83.3%(5/6)呈结节状强化;肝局灶性结节增生动脉期均明显强化.超声造影和CT鉴别肝肿瘤的能力无显著差异.结论超声造影和CT都能敏感地显示不同肝肿瘤的血供特征.     

新型造影剂与灰阶超声造影技术对肝肿瘤的诊断价值

目的探讨新型超声造影剂与实时灰阶造影匹配成像技术观察肝肿瘤的灌注过程及回声变化规律,探讨其对肝恶性肿瘤的诊断价值.方法 35例超声不能完全明确诊断或漏诊的肝占位患者,26例经手术或穿刺病理确诊,9例为造影CT、磁共振等临床资料证实,恶性肿瘤占28例.采用第二代新型造影剂SonoVue以及Technos DU6实时超声造影匹配成像技术.造影剂注射方法分别采用静脉快速团注法和慢注法两种.首先观察了正常肝、肝硬化注射造影剂后各个时相出现的时间及峰值,在此基础上观察了肝占位病变的造影剂灌注过程.结果显示典型的原发性肝癌23例均发生动脉早期强化,21例(91%)呈快速消退即"快进快出"型,另2例＜2 cm的高分化小肝癌表现为动脉早期强化,但消退缓慢.肝转移性肿瘤5例表现多样,呈动脉期或门脉期环状强化或不同程度强化,消退可快可慢.肝血管瘤3例动脉期瘤内无强化,门静脉期呈向心性填充增强,持续时间长,数分钟后消退.对原发性肝癌23例进行了两种不同注射方法的比较,发现团注法使肝癌病灶更快达到增强峰值,更有利于肝癌特征的显示.本组中31例进行了超声造影前、造影后、增强CT的诊断结果比较,肿瘤病灶的显示分别为76灶、99灶、75灶.11例恶性肿瘤病灶数目较造影前增多,其中87%(20/23灶)为3～10 mm小病灶.另5例显示原病灶范围较前增大.结论新型超声造影技术对肝占位病变的定性诊断明显优于常规超声;在显示肿瘤数目尤其发现微小病灶方面更优于增强CT,从而极大地提高了超声对肝占位病变的诊断价值.     

周围型肝内胆管细胞癌的CT和超声双期增强的比较研究

目的比较周围型肝内胆管细胞癌（PIHCC）的CT和超声双期增强的特点,探讨两种方法诊断PIHCC的价值。方法回顾性分析经手术及病理证实的20例PIHCC的CT和超声双期（动脉期和门静脉期）增强的资料。CT动脉期、门静脉期扫描时间分别为注入对比剂后25 s、60 s,超声造影分别为9～40 s、41～120 s。结果肿瘤最大径3.0～16.0 cm,位于肝左叶9例,肝右叶11例。CT双期全瘤低增强8例中超声造影7例（87.5%）表现为全瘤的低增强;CT双期环形增强12例中超声造影10例（83.3%）表现为周边环形增强。超声造影门静脉期瘤内低增强范围较动脉期扩大12例（60%）。PIHCC的CT双期增强方式与超声造影比较无统计学差异（χ^2=1.33,P〉0.05）。动脉期瘤内小血管CT显示4例（20%）,超声造影显示10例（50%）,两者比较有显著性差异（χ^2=4.17,P〈0.05）。结论PIHCC的CT和超声双期增强方式相似,两者均能为诊断PIHCC提供重要信息。超声双期增强显示瘤内小血管优于CT。     

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.     

超声造影对肝癌的诊断价值

目的 探讨超声造影诊断肝癌的临床应用价值.方法 对经临床病理确诊的105例肝癌患者114个癌灶进行常规彩超和实时超声造影检查,分析病灶二维声像图的特点,造影后分析病灶和周围肝实质的增强方式及增强时相.结果 实时超声造影:在114灶中,105灶(92.1%)于动脉相快速均匀增强,100灶(87.7%)门脉相快速退出,5灶(4.4%)实质相退出;6灶(5.2%)于动脉相环状增强,门脉相退出明显早于周围肝实质;3灶(2.6%)为动脉相与肝实质同步非均匀增强或稍晚,门脉相退出早于周围肝实质;将造影时病灶动脉相快速增强早于肝实质和门脉相快速消退的表现作为超声造影诊断肝癌的标准,则本组定性诊断肝癌的敏感性为92.9%(106/114).常规彩超诊断65灶(57.0%),超声造影对肝癌的诊断率明显高于常规彩超(χ2=36.998,P<0.05).结论 超声造影成像可以较清晰地动态显示肝癌各时相血流灌注全过程,具有安全、方便和确诊率高等特点.     

超声造影技术应用于肝肿瘤介入治疗的临床价值探析

目的 探讨超声造影技术在肝脏肿瘤介入治疗后疗效评估中的应用价值.方法 采用微创介入治疗手段对36例肝癌患者（56个病灶）进行不同类型的微创介入治疗,治疗前、后均行超声造影检查及同期CT/MRI检查,比较不同影像学检查方法的特点及可靠性.结果 36例肝癌患者（56个病灶）接受超声造影检查,结果显示其动脉早期呈现球状包裹、弥漫性或轻度的增强,门脉期对比剂迅速廊清.与同期CT/MRI检查比较,超声造影可使肝脏正常组织显影,对于不同类型的肝肿瘤,在不同时间分别显示造影增强,在肝肿瘤与正常组织之间形成较大的反差,提高了肝肿瘤检测的灵敏度、特异度和总符合率.结论 超声造影可以为肝脏肿瘤介入治疗后的疗效评估提供可靠依据,且更适用于恶性肿瘤介入治疗后的疗效评价.     

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。     

肝移植术后早期及晚期肝动脉血栓的超声造影表现

目的 分析肝移植术后早期、晚期肝动脉血栓(HAT)的超声造影表现并对二者进行比较.方法 回顾性分析23例经CT血管造影(CTA)和(或)数字减影血管造影(DSA)确诊的肝移植术后早期(＜1个月)及晚期(≥1个月)HAT患者的超声造影表现.结果 23例肝移植术后HAT患者,早期HAT 9例,超声造影表现为肝内动脉在动脉期、静脉期早期均未见显示,2例出现肝内梗死灶;晚期HAT 14例,超声造影表现为肝外肝动脉不正常显示,肝门部可见细小迂曲的侧支动脉显示,呈网状或片状高增强;肝左动脉、肝右动脉及肝内分支动脉均可见显示,肝实质未见造影剂灌注缺损区.结论 肝移植术后早期、晚期HAT超声造影表现不同,肝内动脉不显示是早期HAT的典型表现.肝外正常肝动脉不显示及侧支形成是晚期HAT的特征表现.     

超声造影在评价经皮肝动脉插管栓塞化疗术后的作用

目的评价超声造影在经皮肝动脉插管栓塞化疗术（TACE）后的作用。方法实时超声造影检查选择TACE术后的原发性肝癌患者21例,共30个肿瘤病灶。结果TACE术后超声造影检查对肿瘤内残存血供的检出率优于能量多勒血流显像;超声造影表现：栓塞完全的病灶在造影的各个时相均表现为“缺损区”,检测到血流的16个病灶有3种形态学表现;通过造影后的表现还可明确提示肿块栓塞后无血供的范围,TACE术后有无门脉内癌栓形成以及肝内有无微小新病灶形成。结论超声造影可作为TACE治疗后常规检查手段以评价其疗效。     

Assessment of the therapeutic response of hepatocellular carcinoma treated with transcatheter arterial chemoembolization: comparison of contrast-enhanced sonography and 3-phase computed tomography.

OBJECTIVE: The purpose of this study was to compare contrast-enhanced sonography with 3-phase computed tomography (CT) in assessing the therapeutic response of hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization (TACE). METHODS: Twenty-nine nodular HCCs treated with TACE were examined with contrast-enhanced sonography, 3-phase helical CT, and conventional angiography. Contrast-enhanced sonographic and CT findings were interpreted separately and prospectively for the presence or absence of contrast enhancement in the treated HCCs. Conventional angiography served as the reference standard. RESULTS: Intratumoral enhancement was seen in 19 HCCs (61%) on contrast-enhanced sonography and 12 HCCs (39%) on CT. Enhancement patterns on sonography were blush in 8 (42%), branching in 2 (11%), nodular in 4 (21%), and stippled in 5 (26%). Of the 19 HCCs with intratumoral enhancement on contrast-enhanced sonography, 13 (68%) showed tumor staining on angiography. Of the 12 HCCs without intratumoral enhancement on sonography, 1 (8%) showed tumor staining on angiography. The sensitivity and specificity of contrast-enhanced sonography in depicting flow in HCCs treated with TACE were 93% and 65%, respectively. The sensitivity and specificity of 3-phase CT were 64% and 100%. CONCLUSIONS: Contrast-enhanced sonography is a more sensitive imaging method than 3-phase CT in depicting vascularity in HCCs treated with TACE.     

灰阶超声造影在肝细胞癌插管化疗栓塞疗效判断中的应用价值

目的探讨灰阶超声造影（CEUS）在肝细胞癌经导管动脉化疔栓塞（TACE）后的疗效判断中的心用价值。 方法经TACE治疗的肝细胞癌患者22例共28个病灶，在行TACE治疗后2～4周内分别对其进行CEUS和增强CT、检查，将其检查结果与病理、影像学随访等其他资料进行综合分析。 结果以数宁血管造影（DSA）检查、病理检查、随访或CEUS和CT的一致判断作为临床判断结果，肿瘤的残留率为71.4％（20／28）。CEUS与增强CT显示肿瘤的残留率分别为75％（21／28），32．1％（9／28）。CEUS判断与临床判断结果无明显差异（P＞0.05），而增强CT判断与临床判断结果之间差异有显著性（P＜0．01）。 结论CEUS能很好的显示肝细胞癌TACE治疗后的血流灌注情况，是评价肝细胞癌TACE治疗效果的一种较好的方法。     

超声造影成像对TACE综合治疗肝癌疗效的评判价值与螺旋CT对比分析

目的与螺旋CT(HCT)对比分析超声造影成像(CEUS)在评价经导管肝动脉灌注化疗药物及碘油栓塞术(TACE)联合经皮无水乙醇注射(PEI)等微创术治疗肝细胞肝癌(HCC)疗效的价值。方法TACE综合治疗后的25个HCC病灶经CEUS和HCT检查,两者阳性检出率进行McNemer检验,并计算二者的诊断准确率。结果CEUS发现10个阳性,出现动脉期增强,15个阴性;HCT发现4个阳性,21个阴性(P<0.05)。与临床追踪对照,CEUS和HCT的准确率分别是96.0%和72.0%。结论与HCT比较,CEUS不受碘油的干扰,能更客观地揭示TACE术后HCC的残存,是评价TACE疗效敏感而有效的方法。     

Hemodynamic changes during balloon-occluded transarterial chemoembolization (B-TACE) of hepatocellular carcinoma observed by contrast-enhanced ultrasound

Balloon-occluded transarterial chemoembolization (B-TACE) is able to achieve denser accumulation of Lipiodol emulsion (LE) in hepatocellular carcinoma (HCC) than conventional TACE. However, to maximize the therapeutic effect of B-TACE, it is imperative to understand the hemodynamic changes that occur during arterial occlusion. We here present two patients with HCC in whom the hemodynamic changes during arterial occlusion were depicted and evaluated by contrast-enhanced ultrasound (CEUS). Arterial flow beyond the catheter tip was observed by CEUS even after balloon occlusion. In one patient, a reduction in arterial blood flow in the HCC was observed by CEUS during balloon occlusion of the target area for embolization. After B-TACE, dense LE accumulation in the HCC nodule was confirmed by flat-panel detector CT, indicating an excellent therapeutic effect. In the other patient, no changes in arterial blood flow in the HCC nodule were observed by CEUS during balloon occlusion of the target area for embolization. After B-TACE, intermediate LE accumulation in the HCC nodule was confirmed by flat-panel detector CT, indicating an incomplete therapeutic effect. The findings obtained in the two patients presented here suggest that B-TACE can be performed more effectively and reliably by monitoring blood flow using CEUS.     

Qualitative diagnosis of hepatocellular carcinoma by contrast enhanced ultrasonography using Coded Harmonic Angio with Levovist

We attempted to evaluate diagnosis and characterization and to access therapeutic effects in cases of hepatocellular carcinoma (HCC) by contrast enhanced ultrasound (CEUS) using Coded Harmonic Angio (CHA) with Levovist, an intravenous ultrasound contrast agent. Fifty-seven HCC foci in 39 patients, including 37 HCC foci in 28 patients before and after transcatheter arterial chemoembolization or radio frequency ablation, were examined by CEUS using the CHA mode, which is under development. This mode uses digitally encoded pulse sequences that identify and suppress nonmoving tissue signals and enhance contrast signals from Levovist in a gray-scale format. In all cases, abundant tortuous intratumoral blood flow was visualized in the early vascular phase by continuous transmission, while tumor stain was recognized by consecutive 1-to-2 second intermittent transmission. Residual tumor area after treatment was also clearly depicted by intratumoral blood flow and partial enhancement. CEUS using CHA with Levovist is likely to become important in the qualitative diagnosis of hepatic tumor and to improve the efficacy of treatment for HCC.     

Quantification of tumor vascularity with contrast-enhanced ultrasound for early response of transcatheter arterial chemoembolization for hepatocellular carcinoma: a report of three cases

Many contrast-enhanced ultrasound (CE-US) studies have been conducted by qualitative analysis of blood flow, such as classification of enhancement pattern. We evaluated early response of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) by quantitative analysis of intratumoral vascularity with CE-US in three patients. Three patients (one man, two women) with HCCs were treated in July 2009. CE-US with perfluorocarbon microbubbles (Sonazoid) and CT were performed serially before and 5 days after TACE. Post-processing enhancement intensity on US was analyzed to determine mean transit time (s), time to peak (s), enhancement peak intensity (dB), and “A” (scaling factor) by ultrasound quantification software after the data were fitted to a gamma variate curve. Mean transit time was prolonged by TACE in all three patients. Mean transit time rates on CE-US were 64.3, 33.8, and 65.6%, respectively, whereas the avascular rates on CT were 59.07, 31.71, and 62.25%, respectively. Mean transit time rates on CE-US approximated avascular rates on CT. Mean transit time rate may quantitatively indicate the early response of HCC to TACE.     

Evaluation of posttreatment response of hepatocellular carcinoma: comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT

We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A better rate of complete response was found in group 1 compared to group 2 (92.7% vs. 78.3%). In RFA treatment, CEUS showed a sensitivity of 83.3% and a specificity of 100% (diagnostic accuracy of 97%) using MDCT as reference standard with no statistical difference (p > 0.05). CEUS detected all cases of incomplete response in HCC treated with TACE using angiography as reference standard (diagnostic accuracy 100%). We recommend assessing residual intratumoral flow on CEUS during RFA procedure to determine the necessity of immediate additional treatment. In case of positive CEUS results, HCC treated with TACE should be considered still viable.     

肝脏孤立性坏死结节超声造影表现

目的探讨肝脏孤立性坏死结节的超声造影表现特征。方法对8例肝脏孤立性坏死结节进行常规超声及超声造影检查,全部病例均经病理证实。记录常规超声检查中病灶大小、形态、边界、回声、彩色血流显像等及超声造影检查中病灶的增强表现。采用Sequoia512超声仪及对比脉冲序列(CPS)造影技术。造影剂选用SonoVue,经肘正中静脉团注。结果8例常规灰阶超声均呈不均质偏低回声结节,形态为葫芦状或融合的分叶状,边界尚清楚,彩色多普勒成像(CDFI)显示内部无血流信号。超声造影特征:8例病灶在造影动脉期、门静脉期及延迟期呈内部无增强表现,5例有动脉期、门脉期周边轻中度环状增强。结论孤立性坏死结节超声造影具有共同的特征性表现,即病变内部三期无增强,周边可伴有或不伴动、门脉期环状增强。超声造影是诊断肝孤立性坏死结节的有价值的检查方法。