超声造影鉴别单纯肝血肿与肝血肿伴活动性出血实验研究  

Differential diagnosis of hematoma and hematoma with liver active bleeding by contrast-enhanced ultrasound:an experimental study

作　　者：宋宏萍[1] 周晓东[1] 任小龙[1] 韩增辉[1] 于铭[1] 张海滨[1] 贺建国[1] 

机构地区：[1]第四军医大学西京医院超声科,陕西西安710032

出　　处：《生物医学工程与临床》2011年第2期116-120,88,共5页Biomedical Engineering and Clinical Medicine

基　　金：军队医药卫生科研基金课题(01MB127)

摘　　要：目的探讨超声造影(CEUS)在鉴别单纯肝血肿与肝血肿伴活动性出血中的应用价值。方法新西兰大白兔15只,雄性,体质量2.5～3.5kg。经肝素化后,用自制小型撞击器撞击肝脏建立肝脏闭合性损伤模型,选10只实验动物随后用活检枪在彩色多普勒超声引导下经皮穿入肝实质损伤肝动脉,制造活动性出血。分别用二维超声及CEUS扫查15只大白兔肝脏,观察是否存在肝血肿和肝活动性出血及其位置。超声检查结束后对实验动物进行剖腹探查,并与超声诊断结果相比较。过量戊巴比妥钠处死实验动物,进行病理学检查。结果共建立肝损伤动物模型15只,其中单纯肝血肿5只,肝血肿伴活动性出血10只。二维超声检测出肝血肿9只(9/15),未发现活动性出血存在(0/10)。CEUS检测出肝血肿15只(15/15),表现为造影剂灌注缺损区,与肝实质界限清晰,造影全部过程中未见造影剂外溢现象。其中10只经CEUS证实合并存在活动性出血(10/10),活动性出血在超声造影中表现为造影剂从肝损伤区域外溢。剖腹探查结果显示肝血肿部位和大小与CEUS检查结果相符,活动性出血部位与CEUS检查结果相符。结论 CEUS是一种快速、有效的鉴别肝脏单纯血肿与血肿伴活动性出血的方法,是否存在造影剂活动性外溢现象是二者的鉴别要点。Objective To evaluate the value of contrast-enhanced ultrasound（CEUS） in differential diagnosis of hepatic hematoma and hepatic hemotoma with active bleeding.Methods New Zealand white rabbits（male,body weight 2.5-3.5 kg,n = 15） were heparinized and subsequently impacted with a self-made impactor to create hepatic blunt injury model.An 18 G semi-automatic biopsy needle was used to create hepatic active bleeding in 10 rabbits by injuring hepatic artery.Both unenhanced and contrast enhanced scanning were performed to evaluate the hepatic injury and search for hematomas and active bleeding sites.After that,the abdomen was opened to check if the injury of liver was identical with the results of sonographic studies.Results A total of 15 liver injury animal models were created,which included 5 cases of liver hematoma and 10 cases of liver hematoma with active bleeding.The 2-dimensional ultrasound imaging confirmed 9 cases of hematomas（9/15） but failed to suggest the presence of active bleeding（0/10）,while contrast-enhanced imaging confirmed 15 hematomas（15/15） and identified 10 active bleeding（10/10）.Active bleeding from contrast-enhanced imaging was displayed in the form that the contrast agent was extravasated from the injured liver parenchyma.The results of pathological examinations were basically matched with the results of sonographic studies.Conclusion It is demonstrated that CEUS is a rapid and effective diagnostic approach for differential diagnosis of hepatic hematoma and hepatic hematoma with active bleeding,wherein the existence of contrast agent active spillover is the main identification point.

关 键 词：肝脏 活动性出血 血肿 超声造影 腹部闭合性损伤 

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]