肝局灶性病变超声造影诊断指标初探

目的 探讨适宜中国肝局灶性病变的超声造影诊断指标。方法 以注射造影剂后肝动脉开始显影作为动脉相的起始时间，以门静脉开始显影作为门脉相起始时间，以肝实质增强达峰值为实质相起始时间；分析682例肝局灶性病变超声造影肝动脉、门静脉的始增时间及肝实质的增强峰值时间、肝内病灶的开始减退时间，分析增强模式。结果 肝硬化与非肝硬化组肝动脉、门静脉及肝实质始增时间有显著差异，肝内良恶性病灶增强退出时间有显著差异。85％的原发性肝癌及99％肝转移癌在注射造影剂后180s内退出，故以180s作为延迟相起始时间及与实质相的划分点，由此将超声造影分为四个时相。结论 由于肝背景不同造成血流动力学差异，病灶增强时相以自身背景对比更为适宜；根据新的时相定义及病灶增强退出特征，总结出中国人肝癌及其他肝局灶性病变的超声造影诊断标准。

Primarily diagnostic criteria of focal liver lesions using contrast enhanced ultrasound

Objective To explore the diagnostic criteria of focal liver lesions using contrast enhanced ultrasound(CEUS).Methods Six hundred and eight-two patients with focal liver lesions underwent CEUS with SonoVue were reviewed.The enhancing start time for hepatic artery,portal vein,liver parenchyma and peak parenchyma enhancing time after contrast injection were recorded.The beginning of arterial phase was defined as the beginning of hepatic artery enhancement,portal venous phase began when portal vein showed enhancement,parenchymal phase began when parenchyma enhancement reached peak.Enhancing time and patterns of focal liver lesions were also analyzed.Results There were significant differences of the enhancing start times for hepatic artery,portal vein and liver parenchyma between patients with and without cirrhosis.The wash-out time of malignant or benign lesions was significantly different.About 85% of hepatocellular carcinomas and 99% of metastases washed out within 180 second,thus 180 second was considered as the dividing point of parenhcymal phase and late phase.And CEUS process was divided into four phases:arterial phase,portal venous phase,parenchymal phase and late phase.Conclusions Due to the individual variation of liver dynamic perfusion,it was better for a diagnostic criteria to describe the enhancement features of focal liver lesion using the newly defined vascular phased based on enhancement time of its own liver vessels.