超声造影鉴别诊断脂肪肝背景下局灶性低回声小病灶

目的探讨CEUS鉴别诊断脂肪肝背景下低回声小病灶（直径≤3 cm）的价值。方法回顾性分析48例脂肪肝患者共54个低回声小病灶的常规超声及CEUS表现。结果 54个低回声小病灶中,病理诊断恶性病灶15个,包括肝细胞癌5个,胆管细胞癌2个,转移癌8个,均表现为快进快出型增强;病理和综合诊断良性病灶39个,13个表现为快进慢出型,3个慢进慢出型,17个同步强化型,5个为无强化型,仅1个表现为快进快出型。实性良、恶性病灶的峰值时间及始退时间差异有统计学意义（P〈0.05）,而始增时间无显著差异（P〉0.05）。CEUS诊断脂肪肝背景下低回声小病灶的符合率为92.59%（50/54）,而常规超声诊断符合率为62.96%（34/54）,差异有统计学意义（P〈0.05）。结论 CEUS能为鉴别脂肪肝背景下良、恶性低回声小病灶提供重要诊断依据,具有重要临床应用价值。

Contrast enhanced ultrasonography in diagnosing small focal hypoechoic lesions with fatty liver

Objective To observe the value of CEUS in differential diagnosis of focal hypoechoic small lesions（diameter≤3 cm） within fatty liver.Methods Imaging features of routine ultrasonography and CEUS of 48 patients with 54 hepatic lesions within fatty liver were analyzed retrospectively.Results Fifteen of 54 lesions were malignant,including 5 hepatocellular carcinomas,2 cholangiocellular carcinomas and 5 metastases.The enhancement type of the malignancies was rapid washin and washout.Thirty-nine lesions were benign.The enhancement type was rapid washin and slow washout in 13 lesions,slow washin and washout in 3,simultaneously enhanced in 17,while 5 lesions showed no enhancement and only 1 lesion showed rapid washin and washout type.The time-to-peak（TTP） and time-to-fade（TTF） between benign and malignant lesions were statistically different（P0.05）,while the arrival time（AT） between them were not statistically different（P0.05）.The diagnostic coincidence of CEUS was 92.59%（50/54）,while that of routine US was 62.96%（34/54,P0.05）.Conclusion CEUS is of great value in diagnosis and differential diagnosis of focal hypoechoic small lesions within fatty liver.