新型超声造影技术对微小肝癌诊断的价值  

Early diagnosis of small hepatocellular carcinoma by new contrast-enhanced ultrasound technique

作　　者：陈敏华[1] 戴莹[1] 严昆[1] 范智慧[1] 吴薇[1] 王艳滨[1] 尹珊珊[1] 杨薇[1] 李吉友[2] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院超声科,北京100036 [2]北京大学临床肿瘤学院北京肿瘤医院病理科,北京100036

出　　处：《北京大学学报（医学版）》2005年第5期458-462,共5页Journal of Peking University:Health Sciences

基　　金：首都医学发展科研基金(ZD199909);北京市重大项目培育专项基金(Z0005190040431)资助~~

摘　　要：目的:分析≤2cm微小肝癌的超声造影增强模式,探讨超声造影新技术对微小肝癌的早期诊断价值。方法:应用新型超声造影剂SonoVue及CnTI实时灰阶超声造影匹配成像技术(CEUS)对392例肝脏局灶性病变行超声造影检查,其中经穿刺活检确认肝硬化合并≤2cm肝细胞癌(HCC),并有病理组织学分类诊断的36例38灶为本文研究对象。全部病例造影后即刻或半个月内均行穿刺活检或手术病理检查。最终确诊为中分化癌22个灶,高分化癌12个灶,透明细胞癌4个灶。结果:造影前常规超声仅对16个灶(42.1%)作出恶性诊断或可疑恶性。造影后38个HCC灶动脉期均不同程度增强;其中中分化癌22个灶均发生快速增强,并在实质期快速消退,呈典型的“快进快出”HCC增强模式;高分化癌12个灶中有9个灶(75.0%)呈“快进慢出”模式;透明细胞癌4个灶中1个灶呈“快进快出”,1个灶呈“快进慢出”模式,2个灶呈“轻度慢进慢出”模式。根据CEUS后增强表现,本组76.3%(29个灶)被确认为恶性,18.4%(7个灶)诊断为可疑恶性,另2个≤1.5cm灶(5.3%)造影增强不典型,未能获得定性诊断。结论:超声造影新技术对肝硬化背景下不同组织类型微小肝癌增强模式的认识为提高微小肝癌的诊断率提供依据。初步结果显示,新型超声造影可作为CT等影像学诊断的互补手段,在小肝癌的早期诊断中发挥重要作用,值得重视推广。Objective： To investigate the diagnostic value of contrast - enhanced ultrasound （CEUS） enhancement patterns of hepatocellular carcinoma （HCC） smaller than 2 cm. Methods： From 392 cases with focal liver lesions undergoing CEUS with SonoVue and Contrast Tuned Imaging （CnTI） technique, thirty six cirrhotic patients with thirty eight HCCs with histopathological diagnosis were retrospectively analyzed in this study. Surgery or needle biopsy was performed within fifteen days after CEUS. Twenty two tumors were finally diagnosed as moderately differentiated HCC, twelve as well differentiated HCC, and four as clear cell carcinomas using Edmondson Grade system. The enhancement patterns of different histopathological HCCs were analyzed. Results： Before CEUS, only 16 lesions （d2.1%） were diagnosed as malignant or possibly malignant. After CEUS, 38 HCCs were enhanced in different degrees following contrast administration,of which, all the 22 moderately differentiated HCCs presented typical “fast - in and fast - out” pattern with fast enhancement in arterial phase and then a quick wash - out in the parenchymal phase. Nine （75.0%） of the 12 well differentiated HCCs presented “fast - in and slow - out” pattern. One of the 4 clear cell carcinomas presented “fast - in and fast - out”, one presented “fast - in and slow - out” and the other 2 presented “slightly slow - in and slow - out” pattern. According to the enhancement patterns, 76.3% （29 tumors） were considered as malignant, while 18.4% （7 tumors） as possibly malignant, only 5.3% （2 tumors smaller than 1.5 cm） could not be diagnosed by CEUS. Conclusion： The identification of different enhancement patterns of various histological types of small HCCs could improve the diagnostic ability of ultrasound in cirrhotic liver. CEUS might be also helpful in detecting small HCCs. Thus CEUS could be a complementary method of enhanced CT and other imaging methods in early diagnosis of HCCs.

关 键 词：超声检查 造影剂 癌 肝细胞 

分 类 号：R735.7[医药卫生—肿瘤]