肝局灶性病变超声造影与增强CT和MRI表现的比较

目的 比较肝局灶性病变CEUS与增强CT(CECT)、增强MRI(CEMRI)表现的异同,并分析差异原因。方法 回顾性分析我院70例肝局灶性病变患者的影像资料,共75个病灶,包括肝细胞癌39个,转移性肝癌6个,胆管细胞癌6个,局灶性结节性增生6个,肝硬化结节5个,肝血管瘤4个,坏死结节4个,其他5个。阅片医师对各时相增强水平、增强类型、有无新发病灶等进行评价。采用Kappa检验评估CEUS与CECT/CEMRI表现及医师阅片结果间的一致性,并分析不一致的影像表现。结果 CEUS与CECT/CEMRI在病灶是否存在确切无增强的坏死或瘢痕区域方面一致性最高(Kappa=0.68);在门静脉期病灶相对于周围肝实质的主要增强水平方面一致性最低(Kappa=0.48)。44.23%(23/52)的恶性病灶及21.74%(5/23)良性病灶的CEUS与CECT/CEMRI表现不完全一致。结论 CEUS与CECT/CEMRI各时相表现一致性较好,差异性表现多集中于恶性病变。病灶影像表现存在差异的原因可能与对比剂不同及病理组织特征等有关。

Enhancement patterns of focal liver lesions: Comparison of CEUS and CECT/CEMRI

Objective To compare the concordance and discordance of enhancement patterns of focal liver lesions on images of CEUS and contrast-enhanced computed tomography (CECT) or contrast-enhanced magnetic resonance imaging (CEMRI), and to explore the causes of discordance. Methods Images of 75 confirmed liver masses, including 39 hepatocellular carcinomas, 6 metastases, 6 cholangiocarcinomas, 6 focal nodular hyperplasias, 5 cirrhotic nodules, 4 hemangiomas, 4 necrotic nodules and 5 other lesions in 70 patients were investigated retrospectively. The readers assessed the contrasted enhancement imaging according to the following parameters: Contrast enhancement of each phase, arrival pattern in the arterial phase, whether new found lesions existing in the late phase, etc. Kappa values were calculated for concordance of modalities and readers. The discordance of CEUS and CECT/CEMRI was analyzed. Results There was good concordance among CEUS, CECT or CEMR, especially for the question about a nonenhancing region (Kappa=0.68), while the concordance was lowest (Kappa=0.48) for the predominant enhancement of lesion relative to that of live on the portal venous phase. On CEUS and CECT/CEMRI images, 44.23% (23/52) malignant lesions and 21.74% (5/23) benign lesions showed discrepancies. Conclusion CEUS shows high concordance with CECT or CEMRI. Malignant lesions have more discrepant displays than benign ones. The discordance may be caused by different contrast agents and pathological characteristics of lesions.