超声造影在肝脏良恶性占位病变诊断中的应用价值

目的：探讨实时超声造影对腹部良恶性占位病变的诊断价值。方法：对207例肝脏占位性病变进行实时超声造影研究，所有病例均经手术或其它影像学检查方法证实。结果：92例肝细胞性肝癌中71例表现为典型“快进快退”，8例表现为“快进慢退”，9例表现为“慢进快退”，4例表现为“慢进慢出”；29例转移性肝癌病灶分为少血供转移癌组13例，表现为动脉相呈环形高增强，门脉相及延迟相呈低增强；多血管转移癌组16例表现为动脉相呈完全高增强，门脉相及延迟相呈低增强。37例肝血管瘤中25个动脉相表现为向心性环形结节状高增强；局造性结节增生表现为中央扩散型快速整体增强，部分病例显示为轮辐状高增强；肝硬化增生结节的造影增强特征与肝实质一致。结论：实时超声造影能显示肿瘤内微小血管的血流灌注情况，对肝脏良恶性占位病变的定性诊断具有重要的参考价值。

Study of contrast- enhanced ultrasound in diagnosis of liver lesions

Objective： To investigate the value of real - time contrast enhanced ultrasound in discrimination benign from malignant tumors of liver occupying lesions. Methods： Totally 207 patients with liver occupying lesions were examined by contrast enhance ultrasound, all cases were confirmed by histopathology or other image methods. Results： After injection of SonoVue 2.4 ml, of the 92 cases of hepatic cell carcinoma （HCC） , 71 presented typically with early artery enhancement and immediate wash -out;8 presented with quick wash -in and slow wash -out;9 presented with slow wash - in and quick wash - out ; another 4 presented with slow wash - in and slow wash - out. The 29 cases of metastatic hepatic carcinoma were divided into 2 groups： less blood supply metastatic carcinoma group （13 cases） , which presented with circular enhancement in low echo in arterial phase and low echo in portal and late phases;and more blood supply metastatic carcinoma group （16 cases）, which presented with enhancement in totally high echo in arterial phase and low echo in portal and late phases. In the 37 cases of hemangioma, 25 lesions were enhanced centripetally and slowly in portal phase. A pattern of a radial centrifugal enhanced in the very early arterial phase and a central stellate fibrous scar in portal phase was observed in FNHs. A pattern of enhancement similar to the surrounding parenchyma was observed in regenerative nodule. Conclusion： Contrast enhanced ultrasound can show microvascular organization and parenchymal perfusion and it is very useful for diagnosing liver occupying lesions.