原发性肝癌实时超声造影时间窗的临床研究

目的 探讨原发性肝癌（HCC）超声造影（CEUS）时间窗及影响因素。方法 经左肘静脉团注造影剂SonoVue 2．4ml后，分别以肝动脉、门脉主干或二、三级分支显影作为动脉相（AP）、门脉相（PVP）的开始，肝实质回声增强达峰值视为实质相（PP）的开始，2min后为延迟相（DP）。结果 肝癌CEUS各时相出现的早晚及持续时间的长短，主要与HCC血供性质有关，血管间短路亦有一定影响。HCC血供分2种形式，第一型最多见，呈动态变化过程。初期以门静脉供血为主，动脉呈低血供，而后二者均减少，随着瘤体的增大，动脉供血逐渐增加呈等血供，直至高血供。第二型则主要以门静脉供血为主。以动脉供血为主的HCC，AP快速强化，PVP消退，该表现见于大多数HCC。以门静脉供血为主者，AP、PVP均强化，至PP方消退，该现象见于小肝癌（sHCC）。动门瘘时可使AP缩短，PVP提前显影。结论 以相关血管显影作为时相的起始及时段，能较全面反映肿瘤特征，有助于定性诊断。主供血管的性质将影响时相的起始及长短。

Study on Time-window of Contrast-enhanced Ultrasound in Primary Hepatocellular Carcinoma

Objective To investigate the time-window of the contrast-enhanced ultrasound (CEUS) in primary hepatocellular carcinoma(HCC)and its influence factors.Methods SonoVue 2.4 ml was injected from the left elbow vein.The beginning of the trunk,second and third branches of hepatic artery or of portal venous enhancement were defined as the beginning of arterial phase (AP) or portal venous phase(PVP) respectively.The beginning of parenchyma phase(PP)was defined as the echo of liver parenchyma became the lightest.The beginning of delayed phase (DP) was defined as 2 minutes after the injection.Results The appearing time and duration of each phase in primary hepatocellular carcinoma CEUS depended mainly on the nature of blood-feeding vessels and also related to whether there were shunts between the vessels.There were two blood-feeding form in HCC.One ordinary forms was a dynamic changing during the whole course.In the initial stage,the major feeding was by portal vein and minor by artery,and then all reduced.Along with the development of the tumor,the arterial blood supply was increased gradually to equal amount with the venous and higher than venous at last.The another form was mainly by portal vein.It was enhanced fast during AP and disappeared during PVP appeared in the CEUS of HCC fed mainly via the artery observed in most HCC.The blood supply enhanced during AP and PVP,and disappeared during PP appeared in the HCC fed mainly via portal vein.It was observed in small HCC (sHCC).Shorted AP and advanced PVP could be observed in HCC having arterial-portal venous shunt.Conclusions Defining the beginning and duration of the phases by the beginning of relevant vessel enhancement can reflect the HCC characteristics overall helpful for the diagnosis of the tumor nature.The beginning and the length of the phase were influenced by the nature of main feeding vessels.