低回声型肝血管瘤的彩色多普勒超声检测

目的　探讨彩色多普勒超声在诊断低回声型血管瘤中的应用价值。方法　应用二维超声、彩色多普勒血流图 (CDFI)、彩色能量多普勒血流图 (PDI) ,结合脉冲多普勒频谱对 18例共 2 2个低回声型肝血管瘤进行研究。结果　 CDFI对低回声型肝血管瘤内血流显示率 2 7.2 7% ,PDI对低回声型肝血管瘤血流显示率 90 .91%。动脉血流检出率为 2 2 .73%。“病灶染色” 9个 (40 .91% )。低回声型肝血管瘤血流呈低速 ,阻力指数 (RI) <0 .6(6 0 % )。结论　彩色多普勒超声对低回声型肝血管瘤的诊断和鉴别诊断有重要价值。     

Hepatic focal nodular hyperplasia: findings with color Doppler sonography

Color Doppler sonographic images of five patients with a total of six lesions of FNH were reviewed. All cases were confirmed pathologically. All six lesions showed increased intralesional flow in comparison to surrounding liver parenchyma on color Doppler sonography. Four of the six lesions showed significant peripheral flow; two of the six lesions showed central flow radiating peripherally from a central vessel. We conclude that increased color Doppler flow may be a characteristic feature of FNH. Increased internal flow has also been reported in HCC and hepatic metastatic disease. Considerable overlap is seen in color Doppler flow patterns. However, in patients clinically at low risk for malignancy, detection of a liver mass with increased color Doppler flow should suggest the diagnosis of FNH.     

Echo-enhanced Doppler sonography of focal nodular hyperplasia of the liver.

Lesions of focal nodular hyperplasia are hypervascular, benign focal liver lesions whose differentiation from other focal liver lesions is of significant clinical relevance. The purpose of this study was to investigate the echo-enhancing agent SHU 508A (Levovist) in the evaluation of focal nodular hyperplasia with Doppler sonography. We examined 49 patients with 71 lesions of focal nodular hyperplasia in the liver with gray scale and power Doppler sonography. In all patients Levovist was administered intravenously in a concentration of 300 to 400 mg galactose per milliliter. Visualization of the feeding vessels and the vascularity of the lesions were evaluated, and the resistive indices in the feeders and the hepatic arteries were assessed. In comparison with unenhanced power Doppler sonography, echo-enhanced power Doppler sonography yields a higher sensitivity in the detection of the feeding artery (97% versus 82%) in focal nodular hyperplasia and in the depiction of the radial vascular architecture in such lesions, especially those located in the left lobe of the liver. Lesions less than 3 cm in diameter do not consistently show a characteristic vascular architecture with echo-enhanced Doppler sonography. The resistive index of the tumor-feeding artery (mean, 0.51 +/- 0.09) is significantly (P < 0.0001) lower than that of the hepatic artery (mean, 0.65 +/- 0.06) and decreases as the size of the focal nodular hyperplasia increases. The administration of Levovist may improve the signal-to-noise ratio and thus visualization of the vascular architecture in focal nodular hyperplasia. Lesions located in the left lobe of the liver, which commonly are subject to disturbing motion artifacts in color Doppler sonography, will significantly benefit from the administration of Levovist. Echo-enhanced power Doppler sonography, however, is not capable of depicting a characteristic vascular pattern in small (< or = 3 cm) lesions of focal nodular hyperplasia that would guarantee a specific diagnosis.     

彩超诊断累及肝脏的遗传性出血性毛细血管扩张症

目的 探讨彩色多普勒超声对累及肝脏的遗传性、出血性毛细血管扩张症(HHT)的诊断价值.方法 观察5例临床确诊的 HHT累及肝脏患者的超声表现. 结果 5例患者均表现为肝固有动脉及肝内动脉分支明显增宽伴走行纡曲、扩张,血流速度增快;1例发现肝内动-静脉瘘,1例合并有肝硬化. 结论 彩超为诊断遗传性、出血性毛细血管扩张症(HHT)提供一种新的检查方法,具有重要临床价值.     

彩超对肝脏囊性病变的鉴别诊断价值

目的　探讨彩色多普勒超声在肝脏囊性病变鉴别诊断中的价值。方法　对临床和病理证实的 2 0例肝脏囊性恶性肿瘤、 2 4例肝脓肿和 4 8例肝脏囊性良性肿瘤 (肝囊肿 )的灰阶超声及彩色多普勒超声表现进行了分析。对每类病灶的大小、形态、边界、囊壁回声、囊内分隔及彩色血流的有无、部位、性质进行统计比较。结果　灰阶超声和彩色多普勒超声可以反映肝脏囊性病变的结构特征及血流特征。肝脏囊性恶性肿瘤中 ,囊壁及囊壁结节内检出血流信号、囊内出现分隔、囊壁有结节或乳头的比例显著高于肝脓肿和肝囊肿 (P<0 .0 5 ) ,以囊内检出血流信号为标准 ,鉴别肝囊性恶性肿瘤的敏感性、特异性分别为 85 .0 %和 94 .4 %。结论　灰阶超声在肝脏囊性病变的鉴别诊断中有一定的意义 ,彩色多普勒在囊壁、分隔或乳头上检出血流信号对肝脏囊性恶性肿瘤诊断具有很高的特异性和敏感性     

Visualization of blood flow in hepatic vessels and hepatocellular carcinoma using B-flow sonography

PURPOSE: A B-flow sonographic technique was recently developed to provide direct visualization of blood flow with gray-scale sonography. Compared with color Doppler sonography, B-flow imaging has wideband resolution and a high frame rate. The purpose of this study was to evaluate the usefulness of B-flow sonography for visualizing blood flow in hepatic vessels and tumor vascularity in patients with liver cirrhosis or hepatocellular carcinoma (HCC). METHODS: Twenty-five patients with liver cirrhosis, including 15 with HCC, were studied by B-flow and color Doppler sonography. Blood-flow detection rates in portal veins and hepatic arteries and tumor vascularity in HCC were analyzed, and the 2 methods were compared. RESULTS: Using B-flow, blood flow was visualized in the portal vein in 23 (92%) of 25 patients and was visualized in the hepatic artery separately from the portal vein in 9 (36%) of 25 patients. The blood-flow signals were visualized only within vessels, never "bleeding" outside the vessel's lumen. Blood flow in the portal vein was observed with color Doppler sonography in all 25 patients, but the hepatic artery was never clearly separated from the portal vein. Vascularity within the HCC tumor was detected in 9 (60%) of 15 nodules with B-flow imaging, and fine arteries flowing into the tumor were observed in 6 nodules. Color Doppler sonography detected blood flow in 13 (87%) of the 15 HCC nodules. CONCLUSIONS: Blood flow in hepatic vessels and tumor vessels of HCC were visualized with B-flow sonography. B-flow sonography is a potentially useful technique for the evaluation of liver vascularity and intratumoral vessels.     

Focal hepatic vein stenoses in diffuse liver disease.

To determine the frequency of focal hepatic vein stenosis in diffuse liver disease and to study the relationship of stenosis to abnormal hepatic venous Doppler waveforms, 92 patients being evaluated for liver transplantation or transjugular intrahepatic portosystemic shunt were prospectively studied with color flow and pulsed Doppler sonography for the presence of focal hepatic vein stenoses and waveform abnormalities. Thirty-six patients had no focal stenoses with normal curves, 26 of 38 patients with Bolondi type I curves had focal stenoses, and 10 of 18 patients with damped type II curves had focal stenoses. Damped hepatic venous velocity curves associated with liver disease probably are caused by increased resistance in the hepatic venous circulation produced by focal stenoses.     

超声对肝局灶性结节样增生的诊断价值

目的探讨肝局灶性结节样增生(FNH)的超声表现及其诊断价值.方法 28例均行超声及生化检查,并均经手术及病理证实.结果 28例FNH中共有30个病灶,超声全部检出.二维超声多表现为低或稍低回声(83%),多发生于近肝缘处(79%);13例彩色多普勒显示动脉频谱者占69%,呈轮辐状血流信号者占23%.生化检查发现所有病例AFP均阴性.结论常规超声结合彩色多普勒超声和AFP阴性可提高FNH的诊断准确性.     

彩超诊断肝移植术后肝动脉血栓和狭窄的价值

目的:探讨彩超对肝移植术后肝动脉血栓和狭窄的诊断价值。方法:彩超检查135例肝移植术后患者的肝实质回声、肝动脉血流、肝动脉阻力指数、收缩期加速度时间、频谱流速曲线形态。结果:彩超发现肝动脉血栓7例。4例出现肝内单发或多发低回声区,6 例显示肝门或肝内无动脉血流,1例表现为肝动脉阻力指数降低和收缩期加速度时间延长,肝动脉狭窄2例,肝动脉阻力指数降低和收缩期加速度时间延长。结论:彩超对肝移植术后肝动脉并发症的检测具有重要价值。     

阻力指数对超声诊断肝脏肿瘤及肿瘤样病变的价值

目的探讨阻力指数（RI）在超声诊断肝脏肿瘤及肿瘤样病变中的价值。方法对143例肝脏肿瘤及肿瘤样病变病人的168个病灶进行彩色多普勒血流显像和脉冲多普勒血流检查分析。结果原发性肝癌90例103个病灶,其中并门静脉癌栓广泛形成3例;转移性肝癌4例11个病灶。肝血管瘤23例28个病灶,肝腺瘤15例15个病灶,肝脏局灶性结节性增生9例9个病灶,炎性假瘤2例2个病灶。12例肝血管瘤14个病灶经CT或（和）MRI扫描及随访得以诊断,3例原发性肝癌并门静脉癌栓广泛形成病人经其他影像学检查及临床实验室检查证实,余者均经手术或穿刺活检病理证实。肝脏恶性肿瘤RI明显高于肝脏良性肿瘤及肿瘤样病变（t=9.74,P〈0.05）。结论 RI在肝脏肿瘤及肿瘤样病变的超声诊断及鉴别诊断中有重要的参考价值。     

Doppler超声和CT在肝癌定性诊断中的对照研究

本文对１０２例（共１１９个）均经手术及／或病理证实的肝内实质占位进行了Ｄｏｐｐｌｅｒ超声（ＣＤＦＩ和ＰＤ）与ＣＴ的对照研究。其中，原发性肝癌６９例（７５个病灶），转移性肝癌５例（６个病灶），肝海绵状血管瘤２２例（３０个病灶），其它病变６例（８个病灶）。结果表明Ｄｏｐｐｌｅｒ（ＣＤＦＩ＋ＰＤ）与常规超声相结合，则其对肝癌定性诊断的特异性（９７．２２％）显著高于ＣＴ诊断的特异性（７１．４５％），同时亦显著高于常规超声特异性（６６．６７％），因而认为Ｄｏｐｐｌｅｒ超声在肝癌定性诊断的特异性方面优于ＣＴ。研究还发现ＣＴ的特异性较低主要是由于≤３ｃｍ组的特异性较低所致。另外，Ｄｏｐｐｌｅｒ超声对肝癌定性诊断的敏感性（９５．１８％）亦高于ＣＴ（９０．１２％），但统计学上无显著性差异（Ｐ＞０．０５），而其准确性（９５．８０％）却显著高于ＣＴ（８４．４８％）（Ｐ＜０．０５），因此Ｄｏｐｐｌｅｒ超声为肝癌诊断提供了一个新的手段。     

Contrast-enhanced power Doppler sonography: improved detection of characteristic flow patterns in focal liver lesions

PURPOSE: The aim of this study was to evaluate whether intravenous injection of an ultrasound contrast agent aids in the visualization of focal liver lesions on power Doppler images. METHODS: Fifty patients with focal liver lesions were studied by B-mode and power Doppler sonography before and after intravenous injection of the contrast agent Levovist (galactose-based microbubbles; 10 ml of a concentration of 300 mg/ml). Thirty-two patients had malignant liver lesions (19 metastases, 12 hepatocellular carcinomas, 1 cholangiocellular carcinoma), while 18 had benign lesions (12 hemangiomas, 2 focal nodular hyperplasias, 4 others). RESULTS: After contrast medium injection, the number of lesions with no intralesional flow dropped from 18 to 9. Flow signal intensity was rated subjectively as marked on contrast-enhanced images in 17 patients; only 4 patients had marked flow on precontrast images. On precontrast studies, central flow in 10 lesions and peripheral flow in 29 lesions could be observed. After enhancement, the numbers increased to 18 and 34 lesions, respectively. CONCLUSIONS: On power Doppler images, a greater number of intratumoral vessels are seen in focal liver lesions after contrast medium administration.     

Power Doppler imaging and evaluation of the resistive index in focal nodular hyperplasia of the liver

Focal lesions of the liver represent a significant diagnostic problem for various imaging modalities. The aim of this study was to assess the value of power Doppler sonography versus conventional color Doppler imaging in the depiction of hypervascular focal nodular hyperplasia (FNH) of the liver and to investigate the resistive index (RI) in the lesions' feeding arteries. Eighteen histologically proved FNHs in 14 patients were evaluated by gray-scale ultrasound, conventional color Doppler, and power Doppler sonography. With conventional color Doppler, a feeding arterial vessel could be depicted in only 4/18 lesions and hypervascularization was detected in 6/18 lesions. Power Doppler was more sensitive in detecting feeding arteries (16/18) within hypervascular lesions (15/18). RI values in the feeding arteries (mean = 0.51) significantly differed from those in the main hepatic artery or its intraparenchymal branches (mean = 0.68) in the same patient. The mean RI-difference was 0.19, suggesting hemodynamically significant arteriovenous shunting. Power Doppler sonography significantly increases sensitivity in the diagnosis of focal nodular hyperplasia of the liver and reliably permits the distinction of these lesions from hepatocellular carcinomas. Received: 17 January 1996/Accepted after revision: 8 May 1996     

彩色多普勒血流显像在肝癌超声引导下介入性治疗中的应用

总结了近两年超声引导下肿瘤内局部注射治疗肝癌３５例病人４０个病灶的彩色普勒超声表现，全部病例经活检证实。治疗前４０个病灶中３２个（８０％）显示有血流，治疗后１３例轿流消失，１４例血流减少，血流的减少或消失多与肿瘤的缩小，回声的增强及ＡＦＰ的下降相一致，是病变良好转归的表现。     

Color Doppler sonography of focal gastrointestinal lesions: initial clinical experience.

Graded compression color Doppler sonography was used to evaluate gastrointestinal blood flow in 20 normal fasting subjects and 32 patients with focal gastrointestinal lesions. Imaging was optimized for color sensitivity using a 5 MHz linear array transducer. Criteria were established for normal mural blood flow based on findings in normal controls. Two reviewers blinded to the final diagnosis compared patterns of mural vascularity in normal and abnormal patients. Increased mural blood flow was demonstrated in all 32 patients with gastrointestinal inflammatory disorders and in seven of nine patients with neoplasms. No mural flow was demonstrated in four patients with small bowel infarction. The greatest overall degree of flow was noted in patients with Crohn's disease and cytomegalovirus colitis. Flow in tumors was variable, ranging from strikingly increased flow in a giant villoglandular polyp to absent flow in a metastasis from lung carcinoma. Our preliminary experience suggests that the presence of considerable overlap in the color Doppler patterns of mural blood flow in inflammatory and neoplastic lesions. Color Doppler sonography alone without spectral waveform analysis may not distinguish focal inflammatory from neoplastic disorders of the gastrointestinal tract reliably. However, this technique potentially may be useful in diagnosing small bowel ischemia when thickened segments of small bowel are identified with absent flow.     

Color doppler sonography avoids misinterpretation of the "parallel channel sign" in the sonographic diagnosis of cholestasis.

PURPOSE: The intrahepatic "parallel channel sign" on gray-scale sonograms is generally interpreted as representing dilated bile ducts, but it may also be caused by enlargement of intrahepatic arteries. This study was performed to evaluate the incidence of misinterpretation of the parallel channel sign without color Doppler sonography and the characteristics of patients in whom misinterpretation of the parallel channel sign is likely to occur. METHODS: A total of 1,100 patients were examined by sonography. All patients with a parallel channel sign on gray-scale sonograms underwent color Doppler sonography. In addition, laboratory values related to cholestasis were measured. RESULTS: The parallel channel sign was observed in 57 patients (5.2%). In 35 (61%) of these patients, color Doppler sonography revealed blood flow in both lumina, indicating that the parallel channel sign was not caused by enlarged bile ducts. Eighty-six percent of this group had nonbiliary liver disease; the enlarged hepatic artery branches were associated with liver cirrhosis in 63% of this group. Color Doppler sonography confirmed that the other 22 patients (39%) had an enlarged intrahepatic bile duct. CONCLUSIONS: Use of color Doppler sonography can help avoid misinterpretation of the parallel channel sign, especially in patients with nonbiliary liver disease.     

Differential diagnosis of hepatic cystic lesions with gray-scale and color Doppler sonography

PURPOSE: This study was conducted to evaluate the effectiveness of sonography, especially color Doppler sonography, in the differential diagnosis of cystic hepatic lesions. METHODS: Ninety-two pathologically or clinically proven hepatic cystic lesions (20 cystic malignancies, 24 abscesses, and 48 simple cysts) were evaluated with gray-scale and color Doppler sonography. The sonographic features were analyzed retrospectively. The percentage, sensitivity, specificity, and positive and negative predictive values of the sonographic features of each disease category were calculated. RESULTS: On gray-scale sonography, the simple cysts were easily distinguished from cystic malignancies and abscesses. While no significant differences were found between hepatic cystic malignancies and hepatic abscesses with respect to the number, shape, margin status, and presence of thick wall of the lesion, the presence of septation and mural nodules was significantly higher in the cystic malignancies than in abscesses. The sensitivity and specificity of color Doppler sonography in differentiating cystic malignancies from abscesses and simple cysts were 85% and 96%, respectively. CONCLUSIONS: Color Doppler sonography provides information about blood flow that supplements that gained on gray-scale sonography, and the presence of color signals in the solid portion of the cystic lesions carries a high diagnostic value in differentiating hepatic cystic malignancies from abscesses and simple cysts.     

Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis.

OBJECTIVE: The purpose of this study was to evaluate the value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. METHODS: Abdominal sonographic and liver Doppler studies were performed in 3 groups: 36 patients with chronic viral hepatitis, 63 patients with cirrhosis, and 30 control subjects with no evidence of liver disease. A series of Doppler indices of hepatic vascularity, including portal vein velocity, portal vein pulsatility score, flow volume of the portal vein, resistive and pulsatility indices of the hepatic artery, modified hepatic index, hepatic vascular index, waveform of the hepatic vein, and focal acceleration of flow, were measured and correlated with liver and spleen size, portal and splenic vein diameter, and presence of ascites and collateral vessels. These indices were compared across the 3 study groups and within the patient groups with respect to presence of inflammation, fibrosis, and steatosis, as determined by histologic evaluation. RESULTS: The most useful indices were portal vein velocity, the modified hepatic index, and nontriphasic flow in the hepatic vein, which were helpful in distinguishing patients from control subjects. Hepatic vascular and modified hepatic indices were useful for differential diagnosis of cirrhosis and chronic viral hepatitis. However, all measurements were limited in their ability to determine the severity of chronic hepatitis. CONCLUSIONS: Doppler sonography is sensitive to hemodynamic alterations resulting from inflammation and fibrosis, and if sonography is the study of choice to follow the progression of hepatitis, it will not be adequate without Doppler imaging. Doppler sonography has high diagnostic accuracy in cirrhosis despite some false-positive conditions. However, it has a limited role in clinical grading.     

Differentiation between benign and malignant hepatic lesions: utility of color stimulated acoustic emission with the microbubble contrast agent Levovist.

OBJECTIVE: This study was undertaken to determine whether the examination of color stimulated acoustic emission in the late phase of Levovist (SH U 508A; Schering AG, Berlin, Germany) enhancement is helpful in the discrimination between benign and malignant liver lesions. METHODS: Fifty-six patients with focal hepatic lesions were examined. Diagnosis of the lesions was confirmed by liver biopsy, computed tomography, or scintigraphy. Thirty-one patients had malignant liver lesions: hepatocellular carcinoma (n = 14), cholangiocellular carcinoma (n = 1), metastasis (n = 14), and lymphoma (n = 2). Twenty-five patients had benign lesions: focal nodular hyperplasia (n = 8), hepatic adenoma (n = 1), focal hyposteatosis or hypersteatosis (n = 6), hemangioma (n = 7), and regenerative cirrhotic nodules (n = 3). After a delay of 5 to 10 minutes without scanning, the liver was examined by color stimulated acoustic emission with a fast sweep of 1 to 3 seconds. RESULTS: All patients with homogeneous color stimulated acoustic emission in the late phase of Levovist enhancement had benign liver lesions (P < .001; specificity, 100%; sensitivity, 68%; positive predictive value, 100%; and negative predictive value, 79%). Eighty-one percent of the patients with nonenhancing lesions in the late phase surrounded by enhanced liver parenchyma had malignant liver lesions (P < .001; specificity, 72%; sensitivity, 94%; positive predictive value, 81%; and negative predictive value, 90%). Interobserver agreement (weighted kappa value) improved from 0.570 +/- 0.038 for baseline sonography to 0.918 +/- 0.028 for color stimulated acoustic emission sonography. The area under the receiver operating characteristic curves for color stimulated acoustic emission sonography (0.927) was significantly higher than for baseline sonography (0.739; P < .05). CONCLUSIONS: Color stimulated acoustic emission in the late phase of Levovist enhancement has a high specificity and sensitivity for differentiation between benign and malignant focal liver lesions.     

彩色多普勒超声造影诊断肝脏肿瘤

目的:研究彩色多普勒超声造影(ECDFI)对肝肿瘤内血流的检测能力和诊断准确性。方法:对75个肝内病灶(良性18个,恶性57个)进行ECDFI检查,结果与CT双期增强扫描和病理检查结果(金标准)比较。结果:ECDFI瘤内血流显示率良性组和恶性组分别为78％和96％,CT动脉期增强分别为83％和98％。ECDFI诊断符合率93％。增强CT87％。结论:ECDFI对于提高肝肿瘤血流显示率和诊断符合率有重要意义,其敏感性、特异性与CT较为一致。