超声造影在肝占位性病变穿刺活检中的应用  

Application of contrast-enhanced ultrasound in biopsy of liver occupying lesions

作　　者：刘友员[1] 程志刚[2] 

机构地区：[1]湖南省第二人民医院超声科,湖南长沙410007 [2]中国人民解放军总医院超声科,北京100853

出　　处：《中国介入影像与治疗学》2010年第2期174-176,共3页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的探讨超声造影在经皮肝占位性病变穿刺活检中的应用。方法对32例常规超声检查诊断的肝占位性病变进行超声造影,根据病灶内微灌注情况,对其中31例进行常规超声引导下穿刺活检,穿刺标本送病理科行组织学检查。取材量满足病理诊断为取材成功。结果常规超声检查提示32例肝占位性病变病灶内坏死、液化3例,超声造影提示病灶内坏死、液化10例;肝多发占位病灶4例,其中1例(2个病灶)1灶造影剂呈"快进快出",另1灶造影三期与肝实质呈同步等增强,其余3例多发病灶超声造影均呈"快进快出";6例常规超声检查病灶未显示血流,5例超声造影检查有不同程度增强,1例病灶三期均呈无增强,考虑局灶性坏死结节未行穿刺活检。31例肝占位性病变于超声造影动脉期增强区取材,平均穿刺2.13次(66/31),取材成功率100%(31/31),确诊率96.80%(30/31)。结论超声造影可敏感地反映肝占位病变微灌注情况,准确分辨肝占位病变坏死、液化区,初步判断病变的良、恶性,指导常规超声准确进行定位取材,在肝占位病变穿刺活检中有重要的临床价值。Objective To evaluate clinical utility of contrast-enhanced ultrasonography（CEUS） in percutaneous liver biopsy of liver occupying lesions.Methods According to intralesional microperfusion situation observed with CEUS,31 of 32 patients with liver occupying lesions underwent liver biopsy under the guidance of conventional ultrasound.Acquirement of adequate quantity of specimen for pathological examination was successfully achieved.Results Of 32 patients with liver occupying lesions,conventional ultrasound indicated intralesional necrosis and liquefaction in 3 patients,while CEUS indicated necrosis and liquefaction in 10 and multiple occupying lesions in 4 patients,of which 1 of the 2 lesions of 1 patient showed a rapid wash-in and washout of a focal contrast agent,the other lesion of the same patient showed synchronized enhancement with liver in all the three phases,and the remaining 3 patients showed rapid wash-in and washout.Of 6 patients conventional ultrasound indicated no blood flow,CEUS showed varying enhancement in 5 patients and no enhancement during all the three phases in 1 patient considered as focal nodular necrosis and did not undergo biopsy.All the 31 patients with liver occupying lesions underwent biopsy in the enhanced area in the arterial phase of CEUS.On the average,each patient was punctured for 2.13 times（66/31）.The successful rate of biopsy was 100%（31/31）.The confirmation rate was 96.80%（30/31）.Conclusion reflecting the situation of microperfusion sensitively,distinguishing necrosis and liquefaction accurately,determining benign or malignant initially and guiding to puncture accurately,CEUS is of great clinical importance in biopsy of liver occupying lesions.

关 键 词：超声检查 造影剂 肝肿瘤 活组织检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575[医药卫生—诊断学]