Sonazoid‐Enhanced Ultrasonography for Evaluation of the Enhancement Patterns of Focal Liver Tumors in the Late Phase by Intermittent Imaging With a High Mechanical Index

Objective. The purpose of this study was to evaluate the enhancement patterns of focal liver tumors in the late phase of Sonazoid‐enhanced ultrasonography by intermittent imaging with a high mechanical index (MI). Methods. A total of 142 patients with 208 lesions, including 109 hepatocellular carcinomas (HCCs), 61 metastases, 30 hemangiomas, and 8 focal nodular hyperplasias (FNHs), were enrolled in this prospective study. Contrast‐enhanced ultrasonography with intermittent scanning at 2 frames per second (MI, 0.7–1.2) was conducted in the late phase (>5 minutes after bolus intravenous injection of the perflubutane‐based contrast agent Sonazoid; Daiichi Sankyo, Tokyo, Japan). Two blinded readers classified the enhancement patterns of the lesions. The sensitivity, specificity, and positive predictive value (PPV) of the dominant enhancement patterns and inter‐reader agreement were assessed. Results. A combination of diffuse enhancement with intratumoral vessels and intratumoral vessels alone yielded sensitivity of 85% (average of both readers), specificity of 88%, and a PPV of 88% for HCC. For metastasis, a combination of peripheral ringlike enhancement with peritumoral vessels and peripheral ringlike enhancement with intratumoral vessels yielded sensitivity of 79%, specificity of 95%, and a PPV of 85%. For hemangiomas, a combination of peripheral nodular enhancement with peritumoral vessels and peripheral nodular enhancement without peritumoral vessels yielded sensitivity of 75%, specificity of 99%, and a PPV of 92%. Diffuse enhancement with spoked wheel arteries yielded sensitivity of 82%, specificity of 100%, and a PPV of 87% for FNHs. Good inter‐reader agreement was achieved. Conclusions. Sonazoid‐enhanced ultrasonography using intermittent imaging with a high MI can potentially be used for evaluating the enhancement patterns of focal liver tumors in the late phase.     

Focal solitary necrotic nodules in fatty liver: characteristics on conventional and contrast-enhanced ultrasonography

PurposeFocal lesions in fatty liver are difficult to diagnose using conventional ultrasonography (CVUS). The aim of this study was to investigate the characteristics of solitary necrotic nodules (SNNs) in fatty liver using CVUS and contrast-enhanced ultrasonography (CEUS) and to evaluate the diagnostic value of CEUS for SNNs in fatty liver.MethodsFifteen SNNs in the fatty liver of fifteen patients were examined by both CVUS and CEUS. The contrast agent SonoVue was used for CEUS. The characterization and shape of these SNNs in the fatty liver were analyzed using CEUS.ResultsCVUS revealed eight oval-shaped, six irregularly shaped, and one wedge-shaped SNN in the fatty liver. The six irregularly shaped lesions on CVUS were revealed to comprise four gourd-shaped, one serpiginous, and one 3-pin socket-shaped nodule on CEUS. One of these SNNs showed a subcapsular wedge shape, with peripheral and distinct internal septal hyperenhancement in the arterial phases that washed out in the portal phase; moreover, most areas of th lesion showed no internal enhancement in any of the three phases. Fourteen of the lesions were characterized as lacking internal enhancement, and 12 of them had mild–moderate peripheral thin enhancement in the arterial phases. Twelve of the 15 nodules could be considered for diagnosis as SNNs by CEUS, which was further proved by US-guided biopsy and histopathology. However none of them could be considered for diagnosis as SNNs by CVUS.ConclusionsCEUS is a valuable tool for visualizing the characteristics of SNNs in fatty liver to improve the differential diagnosis.     

Effect of Observer Experience in the Differentiation Between Benign and Malignant Liver Tumors After Ultrasound Contrast Agent Injection

Objective. The purpose of this study was to assess the impact of the observer level of experience on the diagnostic performance of contrast‐enhanced ultrasound imaging (CEUS) for differentiation between benign and malignant liver tumors. Methods. From a computerized search, we retrospectively identified 286 biopsy‐proven liver tumors (105 hepatocellular carcinomas, 48 metastases, 7 intra‐hepatic cholangiocarcinomas, 33 liver hemangiomas, and 93 nonhemangiomatous benign lesions) in 235 patients (140 male and 95 female; mean age ± SD, 56 ± 11 years) who underwent CEUS after sulfur hexafluoride‐filled microbubble injection. The digital cine clips recorded during the arterial (10–35 seconds from injection), portal (50–120 seconds), and late (130–300 seconds) phases were analyzed by 6 independent observers without experience (group 1, observers 1–3) or with 2 to 10 years of experience in CEUS (group 2, observers 4–6). Specific training in the diagnostic and interpretative criteria was provided to the inexperienced observers. Each observer used a 5‐point scale to grade diagnostic confidence: 1, definitely benign; 2, probably benign; 3, indeterminate; 4, probably malignant; or 5, definitely malignant on the basis of the enhancement pattern during the arterial phase and enhancement degree during the portal and late phases compared with the liver (hypoenhancement indicating malignant and isoenhancement to hyperenhancement indicating benign). Results. The analysis of observer diagnostic confidence revealed higher intragroup (κ = 0.63–0.83) than intergroup (κ = 0.47–0.63) observer agreement. The experienced observers showed higher diagnostic performance in malignancy diagnosis than did inexperienced observers (overall accuracy: group 1, 63.3%–72.8%; group 2, 75.9%–93.1%; P < .05, χ² test). Conclusions. The diagnostic performance of CEUS in liver tumor characterization was dependant on the observer's level of experience.     

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%.     

Value of Contrast‐Enhanced Ultrasonography in Assessing the Vascularity of Liver Metastases

Objective. The purpose of this study was to compare the capability of contrast‐enhanced ultrasonog‐raphy (CEUS) and contrast‐enhanced computed tomography (CECT) in evaluating the vascularity of liver metastases. Methods. Both CEUS and CECT examinations were performed on 70 patients with liver metastases, which were from colon carcinoma in 31, rectal carcinoma in 17, pancreatic carcinoma in 5, and others in 17. In patients with multiple lesions, the most easily observed lesion was selected as the target lesion for evaluation of vascularity. Results. Peak enhancement of the target lesion during the arterial phase was characterized as hyperenhancement, isoenhancement, hypo‐enhancement, and nonenhancement in 61 (87.1%), 6 (8.6%), 3 (4.3%), and 0 (0%) patients on CEUS, respectively, and in 52 (74.3%), 8 (11.4%), 8 (11.4%), and 2 (2.9%) on CECT. Contrast‐enhanced ultrasonography showed more lesions with hyperenhancement than CECT (P < .01). The enhancement pattern during the arterial phase was homogeneous, inhomogeneous, and rimlike in 30 (42.9%), 16 (22.9%), and 24 (34.2%) patients on CEUS and in 13 (18.6%), 8 (11.4%), and 49 (70%) on CECT. Contrast‐enhanced ultrasonography revealed more lesions with homogeneous enhancement than CECT (P < .01). Contrast‐enhanced ultrasonography showed dysmorphic vessels in 33 patients (47.1%) during the arterial phase, whereas CECT showed dysmorphic vessels in 27 (38.6%; P < .01). Contrast‐enhanced ultrasonography showed hypervascular lesions in 58.6% of patients, whereas CECT showed hypervascular lesions in 12.9% (P < .01). Conclusions. Contrast‐enhanced ultrasonography was superior to CECT in assessing the vascularity of liver metastases.     

Characterization of focal liver lesions using contrast-enhanced sonography with a low mechanical index mode and a sulfur hexafluoride-filled microbubble contrast agent

PURPOSE: To characterize focal liver lesions (FLLs) using real-time contrast-enhancedsonography (CEUS) with a low mechanical index mode and a sulfur hexafluoride-filled microbubble contrast agent. METHODS: CEUS was performed in 190 patients with FLLs, including hepatocellular carcinoma (HCC) (n = 107), liver metastasis (n = 21), intrahepatic cholangiocarcinoma (ICC) (n = 7), liver hemangioma (n = 37), focal nodular hyperplasia (FNH) (n = 11), regenerative nodule (n = 6) and liver lipoma (n = 1). The cadence contrast pulse sequencing technique and the contrast agent SonoVue(R) were used for CEUS examination. The enhancement patterns during the arterial, portal, and late phases were evaluated. RESULTS: HCC showed hyperenhancement in 100 (93.5%) of 107 nodules during the arterial phase and hypoenhancement in 102 (95.3%) during the late phase. Liver metastases showed homogeneous enhancement in 8 of 21 (38.1%) nodules and a peripheral regular rim-like enhancement in 11 of 21 (52.4%) nodules during the arterial phase and marked hypoenhancement in 16 of 21 (76.2%) nodules during the late phase. ICC exhibited irregular rim-like enhancement in 4 of 7 (57.1%) nodules during the arterial phase and hypo-enhancement in 7 of 7 (100%) nodules during the late phase. Hemangioma showed peripheral nodular hyperenhancement, and progressive centripetal enhancement was seen in 35 of 37 (94.6%) lesions during the arterial phase. All 11 cases of FNH exhibited homogeneous hyperenhancement during the arterial phase and hyperenhancement (n = 1) or isoenhancement (n = 9) during the late phase. The sensitivity, specificity, and positive predictive value, respectively, were 88.8%, 89.2%, and 91.3% for HCC; 81%, 100%, and 100% for liver metastasis; 57.1%, 100%, and 100% for ICC; 94.6%, 100%, and 100% for liver hemangioma; and 90.9%, 97.8%, and 71.4% for FNH. CONCLUSIONS: Low-mechanical index CEUS permits real-time, complete assessment of vascularity in FLLs, which in turn facilitates their characterization.     

Behavior of Hepatocellular Adenoma on Real‐time Low‐Mechanical Index Contrast‐Enhanced Ultrasonography With a Second‐Generation Contrast Agent

Objective. The purpose of this study was to describe the behavior of histologically proven hepatocellular adenoma (HCA) on low‐mechanical index (MI) contrast‐enhanced ultrasonography (CEUS). Methods. A review of the databases from 4 academic hospitals revealed 18 patients (15 female and 3 male; mean age, 40 years; range, 25–71 years) with 25 histologically proven HCA lesions who were studied with CEUS at a low MI (0.04–0.1). Results. Twenty‐four of 25 lesions (96%; 95% confidence interval [CI], 80.5%–99.3%) showed high‐intensity enhancement, scored as 3 on a scale of 0 to 3, whereas only 1 lesion (4%; 95% CI, 0.7%–19.5%) was scored as 2. The time of peak enhancement ranged between 10 and 19 seconds (average, 13 seconds). All but 1 of the 25 lesions (96%; 95% CI, 80.5%–99.3%) showed early homogeneous and centripetal enhancement during the hepatic arterial phase. No portal venous phase enhancement was observed in any lesion because all showed rapid wash‐out (100%; 95% CI, 86.7%–100%). Twenty lesions (80%; 95% CI, 60.9%–91.1%) were found to be isoechoic to slightly hypoechoic during the portal phase, and 19 (76%; 95% CI, 56.6%–88.5%) were isoechoic to mildly hypoechoic, whereas 7 (24%; 95% CI, 11.5%–43.4%) were hypoechoic during the late phase. Conclusions. Contrast‐enhanced ultrasonography is an effective technique for identifying the microvascular and macrovascular characteristics of HCA. Typically, HCA shows early (10–19 seconds) and centripetal enhancement during the arterial phase and isoechogenicity or mild hypoechogenicity during the portal phase, remaining slightly hypoechoic or isoechoic during the late phase in most cases.     

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.     

超声造影与彩色多普勒超声对肝实质性肿块诊断价值

目的比较彩色多普勒超声和实时超声造影在肝实质性肿块中的诊断价值。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29例患者共33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33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,局限性脂肪肝2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32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性为92%;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,则彩色多普勒超声诊断肝癌的准确性为75%,二者差别有显著性(P<0.05)。结论实时超声造影显著提高肝实质性肿块诊断的准确性,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。     

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.     

Characterization of benign hepatic tumors arising in fatty liver with SonoVue and pulse inversion US

Background We describe the spectrum of contrast-enhancement patterns of benign hepatic tumors arising in fatty liver on contrast-enhanced ultrasound (US). Methods Sixteen patients (12 women and four men) with 27 benign hepatic tumors (17 hemangiomas, eight focal nodular hyperplasias, and two hepatocellular adenomas) arising in fatty liver underwent baseline and pulse inversion US after administration of SonoVue. Two experienced radiologists evaluated baseline echogenicity and dynamic enhancement pattern of each lesion in comparison with adjacent liver parenchyma. Results After administration of SonoVue, in the arterial phase 13 of 17 hemangiomas showed peripheral globular enhancement and one showed a rim of peripheral enhancement, followed by progressive centripetal fill-in, which was complete in 10 of 14 cases and incomplete in four. Three of 18 hemangiomas showed rapid and complete fill-in in the arterial phase. Eight of eight focal nodular hyperplasias became hyperechoic in comparison with adjacent liver parenchyma in the arterial phase and slightly hyperechoic or isoechoic in the portal venous and delayed phases. Both adenomas showed strong arterial contrast enhancement that became less intense in the portal venous and delayed phases. Conclusion Contrast-enhanced US after administration of SonoVue enables depiction of typical contrast-enhancement patterns in most benign hepatic tumors arising in fatty liver, thus providing useful clues for characterization.     

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.     

超声造影对肝脏局灶性脂肪浸润或缺失的诊断价值

目的探讨CEUS对肝脏局灶性脂肪浸润或缺失的诊断价值。方法回顾性分析76例肝脏局灶性脂肪浸润或缺失病例,其中3例经病理学证实,73例经增强CT/增强MRI确诊并随访6个月以上。所有病例均接受常规二维超声及CEUS检查。结果 76例病例中,71例(71/76,93.42%)表现为动脉期、门静脉期及实质期三期等增强,4例(4/76,5.26%)表现为动脉期轻度高增强、门静脉期及实质期等增强,1例(1/76,1.32%)类似肝癌的动脉期高增强、门静脉期及实质期低增强。CEUS诊断局灶性脂肪浸润或缺失与病理或其他检查随访结果的差异无统计学意义(P=0.0625),二者具有相关性(r=0.65,P<0.001)。二维声像图上三期等增强组与动脉期高增强组病灶回声、边界和形态的差异均无统计学意义(P均>0.05)。结论 CEUS对局灶性脂肪浸润或缺失的诊断具有较高的准确率。     

肝局灶性结节性增生的超声造影血流动力学研究

目的 探讨肝局灶性结节性增生的实时灰阶超声造影表现及其诊断价值.方法 对经手术病理证实的34例肝局灶性结节件增生(FNH)患者共36个病灶进行超声检查,观察病灶的常规超声表现和超声造影增强方式及表现并进行分析.结果 36个病灶多为低回声,39%(14/36)病灶周围见低回声环.65%(20/31)病灶内显示特征性的星状或轮辐状彩色血流.超声造影后动脉相观察到3种增强形式:整体型增强28%(10/36),泉涌状增强44%(16/36)和放射状增强28%(10/36).超声造影中搬痕出现率17%(6/36),而对照病理标本瘢痕检出率为40%(6/15).若以超声造影出现其中一种征象(泉涌状增强、放射状增强或瘢痕)作为FNH的诊断指标,则超声造影诊断FNH的符合率达78%(28/36),明显高于常规超声的诊断符合率(28%,10/36).结论 超声造影对诊断FNH有很大价值.     

Hepatocellular carcinoma: assessment of vascularity with single-level dynamic ultrasonography during the arterial phase.

OBJECTIVE: To evaluate the hemodynamic features of hepatocellular carcinoma on single-level dynamic ultrasonography during the arterial phase. METHODS: Twenty-two hepatocellular carcinomas were examined by single-level dynamic ultrasonography with high transmit intensity and SH U 508A. The scans were performed for 40 seconds with a 1-second interval between each ultrasound transmission and with individual optimization of the scan delay time. The times of initiation of enhancement for both the hepatic artery and the tumor and the time of maximal enhancement for the tumor were recorded, and the mean echo values at every second for the tumor and hepatic parenchyma were measured. RESULTS: Twelve tumors showed hyperechoic enhancement compared with hepatic parenchyma throughout the scans. The other 10 showed hyperechoic enhancement during some segments (range, 8-34 seconds) and either isoechoic (n = 5) or hypoechoic (n = 5) enhancement during the remaining parts; the hyperechoic segments were often short (< 20 seconds, 14%). Although the times for initiation of enhancement for the hepatic artery and hepatocellular carcinoma and the time of maximal enhancement for the tumor varied, the tumor usually initiated enhancement immediately after the hepatic artery (r = 0.986; P = .000001). The interval between the time of initiation of enhancement for the tumor or hepatic artery and that of maximal enhancement for the tumor was significantly correlated with the tumor size (r = 0.700; P = .008; and r = 0.780; P = .002). CONCLUSIONS: With individual optimization of the scan delay time, single-level dynamic ultrasonography is useful for depicting the hypervascularity of hepatocellular carcinoma during the arterial phase.     

胰腺神经内分泌肿瘤超声表现

目的 观察胰腺神经内分泌肿瘤的常规超声表现及CEUS特征。方法 回顾性分析我院经手术病理证实的90例胰腺神经内分泌肿瘤的常规超声表现及CEUS表现。结果 90例均接受常规超声、15例接受CEUS检查。90例中,单发肿瘤85例,多发5例;肿瘤位于胰头41例,胰体13例,胰尾36例。二维超声显示低回声81例,囊实混合回声8例,无回声1例,最大径0.80~12.50 cm。67例肿瘤边界清楚,23例边界不清;64例肿瘤形态规则,26例形态不规则。CDFI示35例病灶血流信号丰富。主胰管增粗14例（14/90,15.56%）。15例接受CEUS,其中9例肿瘤动脉期呈高增强,延迟期呈稍高或等增强;4例动脉期呈稍高增强,延迟期呈低增强;2例动脉期周边呈稍低增强,延迟期廓清,内部可见片状不增强区。结论 胰腺神经内分泌肿瘤常规超声多表现为边界清楚、形态规则的低回声团块,CEUS以动脉期均匀高增强、实质期无明显消退为主要特征。     

低回声为主型肾血管平滑肌脂肪瘤常规超声和超声造影特征

目的 探讨低回声为主型肾血管平滑肌脂肪瘤常规超声与超声造影(CEUS)特征.方法 经手术病理证实的11例低回声为主型肾血管平滑肌脂肪瘤患者,均接受常规超声及CEUS,并分析其影像学特征.结果 11例均经手术病理证实为少脂肪或乏脂肪肾血管平滑肌脂肪瘤,其中9例为经典型肾血管平滑肌脂肪瘤,2例为潜在恶性的上皮样血管平滑肌脂肪瘤.常规超声示11例肿块均以低回声为主,肿块内部或周边可见散在点状及小片状高回声;彩色多普勒示2例为富血供肿块,2例为少血供肿块,7例为乏血供肿块.CEUS示3例为"快进快出"型(3/11, 27.27%),8例为"快进慢出"型(8/11,72.73%);7例为边缘型增强(7/11,63.64%),1例为中央型增强(1/11,9.09%),3例为同步增强(3/11,27.27%).结论 低回声为主型肾血管平滑肌脂肪瘤为少见型肾肿瘤,常规超声结合CEUS有助于诊断和鉴别诊断.     

肝脏局灶性炎性病变超声造影分析

目的探讨肝脏局灶性炎性病变的超声造影图像特点,提高超声造影对其诊断的准确性。方法对12例经病理证实的肝脏局灶性炎性病变（肝脓肿5例、肝炎性假瘤4例、肝结核3例）行常规超声及超声造影检查,分析肝脓肿、肝炎性假瘤及肝结核病变常规超声及超声造影图像特点。结果肝脓肿、肝炎性假瘤和肝结核的常规超声主要表现为边界模糊（8/12）的低回声病变（11/12）,病灶内可探及动脉血流信号（6/12）。5例肝脓肿因病变阶段不同而有不同的超声造影表现,但3例肝脓肿周围肝实质出现动脉相一过性节段性强化;4例肝炎性假瘤超声造影表现呈＂快进快出＂型,但动脉相呈边界不清的稍高回声强化,缺乏占位感;3例肝结核病灶中央无强化,周边呈结节状或环状强化。结论肝脏局灶性炎性病变超声造影表现变异较大,但每种炎性病变尚具有一定的特点,并且能反映肝脏局灶性炎性病变不同时期的病理改变,超声造影检查有助于提高肝脏局灶性炎性病变诊断的准确性。     

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