实时超声造影在原发性肝癌鉴别诊断中的应用研究

目的应用实时超声造影技术观察肝细胞癌及肝内胆管细胞癌的血流灌注特征，探讨其对两者的鉴别诊断价值。方法肝细胞癌组患者29例34个结节，肝内胆管细胞癌组患者8例12个结节。观察注射造影剂SonoVue后两组肿瘤结节的血流灌注特征，并用ImageLab软件绘制时间一强度曲线，分析造影增强期及消退期各参数。结果两组造影特征均为“陕进快出”，两组间的时间-强度曲线形态相似，始增时间、峰值时间、增强时间及下降斜率等参数差异均无统计学意义（P〉0．05）。但到达峰值时间时，两组肿瘤结节血流灌注模式的差异具有统计学意义（P〈0．05），肝细胞癌组主要表现为整体型（22／34）或部分型（10／34），肝内胆管细胞癌组主要为周边型（10／12）。结论实时超声造影技术对肝细胞癌及肝内胆管细胞癌有鉴别诊断价值。

A clinical study of real time contrast-enhanced ultrasonography on differential diagnosis of primary hepatic carcinoma

Objective To analyze the blood perfusion characteristics of hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC)using real time contrast-enhanced ultrasonography and discuss its value in the differential diagnosis.Methods The study involved 37 patients with pathological evidence through surgery or needle biopsy,including 29 HCCs with 34 nodules,and 8 ICCs with 12 nodules.The blood perfusion characteristics of two groups were observed after the injection of contrast ultrasound agent(SonoVue).The time-intensity curve of every nodule was draw by ImageLab software(Toshiba)and parameters of the time-intensity curve during contrast enhancement period(enhancement beginning time,peak intensity time,and enhancement time) and falling slope during contrast diminishment period were analyzed.Results All of nodules of two groups presented with early artery enhancement and immediate wash-out.The shapes of the time-intensity curves of the two groups were similar and there were no significance(P> 0.05 ) in differentiating from parameters of the two groups.Three enhancement patterns were observed at time to peak intensity:holistic enhancement pattern,partial enhancement pattern,and peripheral enhancement pattern.There were significance(P< 0.05 ) in differentiating from enhancement patterns of the two groups.The holistic(22/34) and partial(10/34) enhancement patterns were mostly shown in HCC,the peripheral(10/12) enhancement pattern was mostly shown in ICC.Conclusions Real time contrast-enhanced ultrasonography is a promising method to provide useful information for the differential diagnosis of HCC and ICC.