肝超声造影监测和早期诊断微小肝癌的应用价值

背景与目的：我国肝癌发病率高，原发性肝癌常在肝硬化的基础上发生，早期诊断较为困难。本研究应用实时超声造影对肝癌高危患者进行定期跟踪监测，探讨其早期发现和诊断微小肝癌的临床应用价值。方法：2011年2月-2013年11月针对320例肝癌高危患者进行定期的肝常规超声检查和追踪定位的肝超声造影检查，根据肝内病灶在超声造影不同时相的增强表现特点鉴别诊断其良恶性。结果：320例肝癌高危患者定期随访中，经肝超声造影发现和诊断微小肝细胞癌20例，并经手术病理证实，包括直径≤1.0 cm肝癌7例、1.1~2.0 cm肝癌13例。其中6例(30.0%)呈不典型的“快进同出”型表现；病灶小，灰阶超声上呈等回声是超声造影表现不典型的主要因素。结论：常规超声和超声造影对肝癌高危患者的定期跟踪监测，可早期发现微小肝癌，使患者得到及时治疗。

Surveillance and early diagnosis of small hepatocellular carcinoma with contrast-enhanced ultrasonography

Background and purpose: The incidence of liver cancer is high in China. Primary liver cancers usually occur in patients with liver cirrhosis, which is a challenge for the early diagnosis of liver cancer. Our purpose is to investigate the efficacy of contrast-enhanced ultrasonography (CEUS) in the early identification and diagnosis of small hepatocellular carcinoma (HCC) by regularly tracking and supervising the high risk population. Methods: A total of 320 high risk patients of HCC admitted in our hospital from February 2011 to November 2013 were enrolled in this prospective study. All patients underwent conventional ultrasound and hepatic CEUS. The differential diagnosis of malignant HCCs from benign ones was based on the enhancement patterns of hepatic lesions in different phases on CEUS. Results: Twenty patients were diagnosed as small HCC among 320 HCC high risk patients who were under regular surveillance using CEUS and all were pathologically confirmed. Seven of the 20 HCC cases were smaller than 1.0 cm and 13 measured 1.1-2.0 cm. There were 6 (30.0%) HCCs presented as “early wash-in and slow wash-out” atypical pattern of HCC. The small size of the lesion and iso-echogenicity were the main factors of atypical pattern of HCC on CEUS.Conclusion: Ultrasonography and CEUS surveillance is a useful strategy for the early detection of small HCCs in high risk patients, which can help them to receive proper therapeutic management in time.