肝硬化合并小结节样病灶的常规超声和超声造影对比分析

目的:对比分析肝硬化合并小结节样病灶(≤3cm)的常规超声和超声造影(CEUS)显像特征。方法:应用造影剂SonoVue及对比脉冲序列技术(CPS)对常规超声检出的69灶肝硬化合并的小结节样病灶进行CEUS观察,所有病灶均行穿刺活检或手术切除病理证实。结果:分析本组69个病灶随不同造影时相增强的特点,发现从大再生结节(LRN)、低度增生不良结节(DN)、高度DN、高分化肝细胞癌(SHCC)至中低分化SHCC组开始增强时间和完全消退时间均呈递减趋势;并由本组归纳总结6种CEUS增强模式,各组结节增强模式构成分别不同,92.3%的LRN为模式Ⅰ～Ⅱ型,58.3%的LGDN为模式Ⅲ型,83.8%的HGDN主要为模式Ⅳ型,83.3%的SHCC为模式Ⅴ和Ⅵ型,其中高分化SHCC主要为模式Ⅴ型,低分化SHCC具有特征性模式Ⅵ型,1例癌变DN表现为混合型模式(Ⅲ+Ⅴ)型。CEUS判断不同病灶良恶性优于常规超声(P<0.01);CEUS和增强CT对本组病灶不同时相增强结果一致。结论:CEUS提高了超声显像对肝硬化癌变过程中小结节病灶的定性诊断价值。

Contrast-enhanced Ultrasonography of Different Focal Nodular Lesions during Hepatocarcinogenesis Complicating Cirrhosis

Objective To explore the difference of contrast-enhanced phase and pattern in different focal nodular lesions smaller than 3cm during cirrhotic hepatocarcinogenesis and its value on differential diagnosis by observing imaging characteristics of those nodules using contrast-enhanced ultrasonography(CEUS) and comparing with Doppler ultrasonography(DUS) and contrast-enhanced helical CT appearance.Methods 69 focal noduler lesions found in 58 cirrhotic patients by conventional ultrasonography were studied using SonoVue and Contrast Pulse Sequencing(CPS) technique and their CEUS characteristics were analyzed.All the nodules were underwent ultrasound-guided biopsy or surgery.13 large regenerative nodules(LRN),26 dysplastic nodules(DN) and 30 small hepatocellular carcinomas(SHCC) were confirmed pathologically.Results After CEUS,the beginning-enhanced time and entire wash-out time showed desending trend along LRN,LGDN,HGDN,welldifferentiated SHCC and medium-poor-differentiated SHCC.Six enhancement patterns were summerized in this study,92.3% LRN presented Ⅰ or Ⅱ patterns,58.3% LGDN presented Ⅲ pattern,83.8% HGDN mostly presented Ⅳ pattern,83.3% SHCC presented Ⅴ or Ⅵ patterns,well-differentiated SHCC mostly presented Ⅴ pattern,medium-poor-differentiated SHCC presented distinctive pattern Ⅵ,one case of DN which turn malignant presented mixed pattern Ⅲ and Ⅴ.The ability of CEUS in differentiating malignant from benign or precancerous nodules is superior to that of conventional ultrasound(P<0.01).There was no significance(P>0.05) in enhanced effect by CEUS and contrast-enhanced CT.Conclusion CEUS improved the power of conventional ultrasonography in judging the nature of focal nodular lesions in cirrhotic livers and from observing the difference of CEUS phase and pattern can we make preliminary estimation on their development,evolvement and pathological types during hepatocarcinogenesis.