肝血管瘤超声造影定量特征

目的探讨肝血管瘤超声造影定量特征。 方法选取2013年10月至2015年4月同济大学附属第十人民医院收治的肝血管瘤患者42例。38例经CT及磁共振成像证实，4例经手术病理证实为海绵状血管瘤。利用SonoLiver软件进行定量分析，以病灶与其周围正常肝实质的增强水平差值为参数进行动态血管模型（DVP）参数成像。分析肝血管瘤及病灶周围肝实质的峰值强度（Imax）、上升时间（RT）、达峰时间（TTP）、平均渡越时间（mTT）、灌注指数（PI）及DVP曲线。采用t检验分别比较肝脏大血管瘤、肝脏小血管瘤与病灶周围正常肝实质、肝脏大血管瘤与肝脏小血管瘤、肝血管瘤中央部与边缘部Imax、RT、TTP、mTT、PI差异。 结果肝脏大血管瘤、肝脏小血管瘤的Imax、PI均高于病灶周围正常肝实质，RT、TTP、mTT均短于病灶周围正常肝实质，且差异均有统计学意义（t值分别为6.467、-14.758、-9.772、-3.753、4.157，P均<0.05）。肝脏大血管瘤Imax高于肝脏小血管瘤，且差异有统计学意义（t=4.146，P<0.05）；肝脏大血管瘤与肝脏小血管瘤RT、TTP、mTT、PI差异均无统计学意义。肝血管瘤中央部Imax高于肝血管瘤边缘部，RT、TTP均长于肝血管瘤边缘部，且差异均有统计学意义（t值分别为7.087、8.091、8.654，P<0.01或0.05）；肝血管瘤中央部与边缘部mTT、PI差异均无统计学意义。肝血管瘤的DVP曲线及DVP参数图均可分为3种类型：Ⅰ型，消退型；Ⅱ型，未消退型；Ⅲ型：负向型。本组肝血管瘤患者DVP曲线、DVP参数图呈Ⅰ型、Ⅱ型、Ⅲ型分别为16例（16/42，38.1%）、20例（20/42，47.6%）、6例（6/42，14.3%）和15例（15/42，35.7%）、10例（10/42，23.8%）、17例（17/42，40.5%）。 结论肝血管瘤的TTP和mTT短于病灶周围肝实质。肝脏大血管瘤的Imax和PI高于肝脏小血管瘤。肝血管瘤内边缘部RT及TTP比中央部快。DVP曲线可直观显示肝血管瘤与病灶周围肝实质血流灌注的差异。

Characteristics of parametric imaging of contrast-enhanced ultrasound for hepatic hemangioma

ObjectiveTo investigate the characteristics of parametric imaging of contrast-enhanced ultrasound (CEUS) in evaluating hepatic hemangioma. MethodsTotally 42 cases of patients with hemangioma were selected from October 2013 to April 2015 in the Tenth People's Hospital of Tongji University. Thirty-eight cases were confirmed by CT and magnetic resonance imaging (MRI), and 4 cases were confirmed by surgery pathology for cavernous hemangioma. SonoLiver CAP software was used to quantitatively analyze the CEUS and calculate dynamic vascular imaging model parameters (DVP) based on the enhancement difference between lesions and surrounding normal liver parenchyma. The peak intensity (Imax), the rise time (RT), time to peak (TTP), mean transit time (mTT), perfusion index (PI) and DVP curve of hemangioma and surrounding parenchyma were analyzed. T test was used to compare the differences of Imax, RT, TTP, mTT and PI among the large liver hemangioma, small liver hemangioma and surrounding normal liver parenchyma, between large liver hemangioma and small liver hemangioma, and between the edge and central part of liver hemangioma, respectively. ResultsImax and PI in both large hemangioma and small hemangioma were higher than that in normal liver parenchyma; RT, TTP and mTT were shorter in the surrounding normal liver parenchyma, and the differences were statistically significant. Imax in large liver hemangioma was higher than that in small hemangioma, and the difference was statistically significant. The difference of RT, TTP, mTT and PI between large hemangioma and small hemangioma were not statistically significant. Imax in central part was higher than that in the edge part of liver hemangioma. RT, TTP in central part were also longer than that in edge part, and the difference had statistical significance. mTT and PI in both large and small hemangioma had no significant difference. DVP curves and DVP parameter figures of liver hemangioma can be divided into three types: type Ⅰ, positive model with gradual washout; type Ⅱ, positive model with no washout; type Ⅲ, negative model. For DVP curves and DVP parameter , type Ⅰ, type Ⅱ and type Ⅲ respectively had 16 cases (16/42, 38.1%), 20 cases (20/42, 47.6%), 6 cases (6/42, 14.3%) and 15 cases (15/42, 35.7%), 10 cases (10/42, 23.8%), 17 cases (17/42, 40.5%). ConclusionsTTP and mTT of hemangiomas was shorter than the surrounding liver parenchyma by using contrast-enhanced ultrasound imaging parameters. The Imax and PI in large hemangioma was higher than that in small hemangioma. The RT and TTP in hemangioma edges was faster than that in central parts. The difference of blood perfusion in the liver hemangioma and surrounding liver parenchyma could be shown by DVP curve.