动态灰阶超声造影在肝肿瘤鉴别诊断中的应用

目的 探讨动态灰阶谐波超声造影在肝肿瘤鉴别诊断中的作用。方法 选择24例肝内实质性占位病变进行灰阶谐波超声造影和动态观察，全部病例均经手术和病理证实。造影剂选用Levovist，浓度为400mg／m1，以团注形式经肘部浅静脉注入。结果 24例患者证实25个病灶，其中肝癌16个，肝血管瘤3个，肝局灶性结节性增生(FNH)2个，肝炎性假瘤1个，肝血管平滑肌脂肪瘤(AML)3个。除肝炎性假瘤外，其余病灶经超声造影后均有不同程度的增强。肝癌动脉相呈早期强化，消失较快；肝血管瘤增强速度较慢，呈周边强化；FNH和AML亦早期增强，但持续时间较长。如以动脉相增强呈高回声而门脉相消失呈低回声音考虑为肝癌，反之考虑为良性肿瘤，则本组超声造影诊断肝癌的敏感性、特异性及准确性分别为94％(15／16)，89％(8／9)，92％(23／25)。结论 动态灰阶谐波超声造影对提高肝肿瘤的鉴别诊断具有实用价值。

Differential diagnosis of hepatic tumors with dynamic grey-scale enhanced ultrasonography

Objective To evaluate the value of dynamic grey-scale enhanced ultrasonography in the differential diagnosis of hepatic tumors.Methods Twenty-four patients with 25 hepatic solid lesions were examined by dynamic enhanced ultrasonography with a bolus injection of Levovist (400 mg/ml). Results All lesions were confirmed by operation and pathology, including 16 hepatocellular carcinomas (HCC), 3 hepatic hemangiomas (HCH), 1 inflammatory pseudotumor of liver (IPL), 2 focal nodular hyperplasias (FNH) and 3 angiomyolipomas (AML). Twenty-five lesions were variously enhanced on grey-scale ultrasonogram after injection of Levovist except for IPL. The lesions with HCCs were enhanced early in the arterial phase and disappeared quickly in portal phase. The lesions with HCHs were enhanced slowly in the peripheral region of the lesion. The FNH and AML were also enhanced early in arterial phase, but disappeared slowly in delay phase. If the hepatic lesions showed the earlier enhancement in arterial phase and fast disappearance in portal phase on contrast enhanced ultrasonogram were regarded as a criterion of malignant tumor, the sensitivity, specificity and accuracy with contrast enhanced ultrasonography in the diagnosis of hepatic malignant tumor were 94%(15/16),89%(8/9)and 92%(23/25), respectively. Conclusions The dynamic grey-scale enhanced ultrasonography is a useful technique in the differential diagnosis of hepatic tumors.