超声造影对肝局灶性小病变伴肝灌注异常的研究  

Preliminary study on hepatic perfusion disorders in small focal liver lesions with contrast-enhanced ultrasonography during arterial phase

作　　者：何炜[1] 周平[1] 朱文晖[1] 罗卓琼[1] 肖丽[1] 李瑞珍[1] 李少君[1] 廖曼琼[1] 王维[2] 

机构地区：[1]中南大学湘雅三医院超声科,长沙410013 [2]中南大学湘雅三医院放射科,长沙410013

出　　处：《中华超声影像学杂志》2008年第8期685-689,共5页Chinese Journal of Ultrasonography

摘　　要：目的运用灰阶实时超声造影（CEUS）观察肝局灶性小病变（≤3cm）伴动脉相肝灌注异常——一过性肝高增强（THHE）的显像特征及鉴别诊断价值，探讨可能的发生机制。方法运用超声造影剂SonoVue及对比脉冲序列（CPS）造影成像技术检查268灶肝局灶性小病变，回顾性观察病变周围出现THHE的CEUS声像图特征，分析其伴随不同性质病变的发生率、形态及增强特征。结果268灶肝局灶性小病变中45灶（16．8％）周围检测出THHE。CEUS表现为肝动脉相病变周围不同形态和范围的快速高增强区域，边界清晰，随即快速消失呈等增强。平均增强持续时间为（22．6±13．6）s。THHE的形态分为4型：Ⅰ型，楔形或扇形（51．1％）；Ⅱ型，环状包绕形（20．0％）；Ⅲ型，类结节形（11．1％）；Ⅳ型，不规则形（17．8％）。根据病变的性质分为3组：①良性肿瘤组88灶，8灶（9．1％）出现THHE，7灶呈Ⅲ型和Ⅵ型；②恶性肿瘤组141灶，31灶（22．0％）出现THHE，21灶呈Ⅰ型；③瘤样病变组39灶，6灶（15．4％）出现THHE，4灶呈Ⅱ型。三组病变周围THHE的CEUS增强分型构成比较差异有统计学意义（P〈0．001），良性肿瘤组THHE出现率低于恶性肿瘤组和瘤样病变组（P〈0．05）。结论CEUS检出的肝局灶性小病变伴THHE是动脉相肝灌注异常的声像表现，在不同性质病变其发生率和形态构成略有不同，充分识别THHE有助于鉴别诊断、避免误诊及正确评估病变范围。Objective To investigate the imaging characteristics and differentiating value of hepatic perfusion disorders （HPD） in small focal liver lesions（≤3 cm）, the transient hepatic hyperechoic enhancement （THHE）, with contrast enhanced ultrasonography （CEUS） during arterial phase and explore the potential mechanism. Methods Two hundred and sixty eight small focal liver lesions found in 215 patients who had undergone CEUS were retrospectively evaluated in this study. Hepatic parenchymal THHEs around those lesions were diagnosed and the CEUS characteristics as well as the detecting rate related to different lesions were analyzed. Results Forty five among 268 lesions （16.8%） showed surrounding THHEs during CEUS and they exhibited fast wash-in to form hyperechoic area of different shape and range and then those area became fast washout to he isoechoic in contrast with peripheral liver parenchyma. According to the imaging morphology,THHEs could be divided into four types ： type Ⅰ , wedge-or fan-shaped（51.1 % ） ; type Ⅱ , encircling shaped （20.0 % ） ; type Ⅲ ,nodule-like-shaped（ 11.1 % ） ; type Ⅳ, irregular-shaped（ 17.8% ）. According to the pathology, the liver focal lesions could be divided into three groups： benign group, which consisted of 88 lesions and 8 （9.1%） lesions showed surrounding TH HEs of which 87.5 % presented type Ⅲ and Ⅳ ;malignant group,which consisted of 141 lesions and 31 （22.0 % ）lesions showed surrounding T H H Es of which 67.7 % presented type Ⅰ ;tumor-like lesions group,which consisted of 39 lesions and 6 （15.4%） lesions showed surrounding THHEs of which 66.7% presented type Ⅱ. There was significant difference in the composition of THHEs type among three groups（ P 〈 0. 001）. The detecting rate of THHEs in benign group was lower than that in other groups （ P 〈 0.05）. Conclusions THHEs showed with CEUS in small liver focal lesions are representation of HPD and have different detecting rate and imaging morphology type in di

关 键 词：超声检查 微气泡 肝疾病 

分 类 号：R686[医药卫生—骨科学]