超声造影对肝硬化癌变相关局灶性小结节的诊断研究  

Investigation of Differentiating Small Focal Nodules Related to Cirrhosis during Hepatocarcinogenesis Using Contrast-enhanced Ultrasonography

作　　者：何炜[1] 朱文晖[1] 周平[1] 罗卓琼[1] 李瑞珍[1] 

机构地区：[1]中南大学湘雅三医院超声科,长沙市410013

出　　处：《中国超声医学杂志》2008年第10期919-922,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的运用灰阶超声造影(CEUS)观察肝硬化癌变相关局灶性小结节(≤3cm)的显像特征,探讨不同性质病灶的造影增强模式的差异及其鉴别诊断价值。方法运用超声造影剂SonoVue及对比脉冲序列技术(CPS)研究68例肝硬化患者合并的75个肝脏实性局灶性小结节的CEUS显像特征。所有病灶均行穿刺活检或手术切除,病理证实为15个大再生结节(LRN)、27个增生不良结节(DN)和33个小肝癌(SHCC),将各组结节的CEUS增强特征与常规超声和CT增强扫描进行对比。结果CEUS可持续观察病灶及邻近肝实质内造影剂进入直至消退的整个动态过程,可以更准确地反映病灶的微血管灌注及增强特点,CEUS准确判断肝硬化癌变相关局灶性小结节性质的能力优于常规超声(P<0.01),CEUS和增强CT对本组病灶不同时相增强显像结果一致(P>0.05)。结论CEUS对于肝硬化癌变相关局灶性小结节具有较为准确的定性诊断价值,对病灶内血流灌注的评估优于增强CT。Objective To explore the value of contrast-enhanced ultrasonography （CEUS） in differentiating various focal nodules smaller than 3cm during hepatocarcinogenesis in cirrhosis. Methods Seventy-five focal nodules found in 68 cirrhotic patients on conventional ultrasonography were studied using SonoVue and contrast pulse sequencing （CPS） technique as well as three-phase contrast spiral CT and their imaging characteristics were analyzed. All the nodules underwent ultrasound-guided biopsy or surgery. Fifteen large regenerative nodules （LRN）, 27 dysplastic nodules （DN） and 33 small hepatocellular carcinomas （SHCC） were confirmed pathologically. Results CEUS could accurately display the dynamic course of mirobubbles＇ wash-in and wash-out from the nodules and peripheral parenchyma. CEUS was superior to conventional ultrasounography in judging the nature of various nodules having hepatocarcinogenesis process tendency in cirrhotic liver （P〈0.01） . There was no significance （P〉 0.05） in enhanced effect between CEUS and contrast enhanced CT. Conclusions CEUS is an effective imaging technique for characterizing the nature of focal nodular lesions related to hepatoearcinogenesis in cirrhotic livers and superior to contrast-enhanced CT in assessing the feeding vessels in the focal nodules.

关 键 词：超声造影 肝硬化 结节 小肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤] R737.9[医药卫生—临床医学]