超声造影对肝脏小占位病变的诊断价值

目的分析较小肝脏占位性病变（直径≤3cm）超声造影表现,探讨超声造影对肝脏小占位病变的诊断价值。方法回顾性分析136例患者156个直径≤3cm的肝脏占位性病变常规超声及超声造影表现,其中恶性病灶74个,良性病灶82个。利用TIC软件分析除外术后瘢痕、坏死结节及性质待定的病灶外的142个病灶造影剂灌注模式,并与病理结果进行对照研究。结果74个恶性病灶及除坏死结节、术后瘢痕外的72个良性病灶不同程度增强。动脉相原发性肝细胞癌（HCC）100%（49/49）增强,其中71.43%（35/49）呈整体增强;实质相85.71%（42/49）呈典型的＂黑洞＂征。转移性肝癌动脉相特征性地表现为厚环状增强者占52.00%（13/25）;实质相88.00%（22/25）呈＂黑洞＂征。良性病变中动脉相后期呈整体增强、斑片状增强及环状增强者分别为48.61%（35/72）、18.06%（13/72）、33.33%（24/72）;实质相呈＂黑洞＂征、强度低于、近似于周围肝组织者分别为1.39%、30.56%、68.06%。肝血管平滑肌脂肪瘤和炎性假瘤造影呈快进快退,类似于恶性肿瘤。TIC分析良性病灶始增时间、增强时间及达峰时间均晚于恶性病灶,差异具有显著性,峰值强度在两组之间无显著性差异。HCC和转移性HCC上述参数无差异。血管平滑肌脂肪和炎性假瘤TIC上述各参数低于良性组其余病变。结论超声造影对提高肝脏小占位病变的定性诊断率有重要的价值,部分良性病变造影表现缺乏特异性,确诊仍须结合其他影像学方法或穿刺活检。

Contrast-enhanced ultrasound in the diagnosis of small hepatic lesions

Objective To observe the characteristics of small hepatic lesions （≤3 cm） with contrast-enhanced ultrasound （CEUS） and evaluate the role of CEUS on the diagnosis of small liver neoplasms. Methods The appearances on CEUS of 136 patients with 156 lesions were studied retrospectively, including 74 malignant cases and 82 benign ones. The time-intensity curve （TIC） of 142 lesions was obtained with computer-assisted software. The characteristics and the parameters of TIC were analyzed correlated with pathological findings. Results Enhancement was found on 146 cases except necrosis nodus and postoperative scars. All （49 cases） the hepatocellular carcinomas （HCC） enhanced in arterial phase, 71.43 % （35/ 49） of them enhanced globally. In parenchymal phase, 85.71% （42/49） presented as black hole . Typical thick-ringed en- hancement was found on 52. 00% （13/25） of the metastases in arterial phase and 88. 00% （22/25） of them showed as black hole in parenchymal phase. Of benign lesions enhancement can be global （48.61%）, patchy （18.06%） and ringed （33.33%） in arterial phase. In parenchymal phase, the proportion of ＂black hole＂ sign was 1.39%, with 30.56% lower than and 68.06% similar to the liver parenchyma. The appearances of inflammatory pseudotumor and angiomyolipomas on CEUS were rapid wash-in and wash-out, similar to malignant lesions. The acoustic quantified parameters of TIC including the time to arrival, time of enhancement and peak time in benign lesions were significantly later than those of the malignant lesions. The difference of the peak intensities between the two groups was not statistically significant. There was no significant difference between primary hepatic carcinomas and metastases. The above mentioned parameters of inflammatory pseudotumor and angiomyolipomas were earlier than those of other benign lesions. Conclusion CEUS has an important clinical value in qualitative diagnosis of liver lesions. The appearances of some benign lesions are atypical, further diagnosis depends on other imageology technique or needle biopsy.