肝局灶性病变超声造影的误诊病例分析

目的 探讨肝局灶性病变超声造影的误诊因为.方法 收集有病理诊断的578例肝局灶性病变的超声造影资料,将其中与病理诊断不符的75例进行回顾性分析.结果 29例肝良性病变被超声造影误诊为肝癌,占误诊的38.7%.20例肝癌被超声造影误诊为肝良性病变,占误诊的26.7%.13例肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)被误诊为肝细胞癌(hepatocellular carcinoma,HCC).4例HCC被误诊为ICC.1例胆道乳头状黏液腺癌、1例肝转移癌和1例神经内分泌癌被误诊为HCC,1例HCC和1例ICC被误诊为肝转移癌.3例肝增生病变和1例炎性假瘤被误诊为肝血管瘤.原发性肝癌与肝内增生病变的混淆诊断占误诊的首位,炎性病变与恶性肿瘤的混淆诊断居次位.结论 不同病变的增强模式相似是超声造影出现误诊的原因,分析造影图像细节,紧密结合临床,可提高超声造影的诊断准确率.

Misdiagnosis analysis of contrast-enhanced ultrasonography for focal liver lesions

Objective To analyze the misdiagnosis reasons of contrast-enhanced ultrasonography for focal liver lesions(FLLs).Methods Seventy-five cases misdiagnosed by contrast-enhanced ultrasonography from 578cases confirmed by pathologic diagnosis in the past five years were analyzed.Results of 75 cases,29(38.7%)benign lesions were misdiagnosed as hepatocarcinoma,20(26.7%)malignant FLLs were misdiagnosed as benign lesions.Thirteen cases of intrahepatic cholangiocellular carcinoma(ICC)were misdiagnosed as hepatocellular carcinoma(HCC),and 4 cases of HCC were misdiagnosed as ICC.Three cases of other malignant FLLs were misdiagnosed as HCC,and 2 primary carcinomas were misdiagnosed as liver metastases.Three hyperplasia lesions and 1 inflammatory pseudotumor were misdiagnosed as hemangioma.Misdiagnosis of HCC and hyperplasia lesions from each other ranked first,and misdiagnosis of inflammatory disease and malignant FLLs ranked second for them were prone to be confused.Conclusions Misdiagnosis occurred for variety diseases with similar enhancement pattern of contrast-enhanced ultrasonography,so dynamic contrast-enhanced ultrasonography images must be analyzed carefully to find details to differentiate FLLs,and clinical history must be combined with tightly to improve diagnostic accuracy.