超声造影对肝硬化背景下肝细胞性肝癌和血管瘤的诊断及鉴别  

Differential Diagnostic Value of Contrast-Enhanced Ultrasonography in Hepatocellular Carcinoma and Hepatic Hemangioma Patients with Hepatic Cirrhosis

作　　者：周素芬[1,2] 尹家保[1,2] 杨浩[1,2] 吕瑾玉[1,2] 钟静[1,2] 安鹏[1,2] 

机构地区：[1]湖北医药学院附属襄阳医院 [2]湖北省襄阳市第一人民医院超声科,湖北襄阳441000

出　　处：《武汉大学学报（医学版）》2012年第6期833-837,共5页Medical Journal of Wuhan University

基　　金：湖北省襄阳市科技基金项目(编号:2011-5)

摘　　要：目的:分析在肝硬化背景下超声造影对肝细胞性肝癌及肝血管瘤的诊断及鉴别诊断。方法:回顾性分析54例均经临床诊断为肝硬化并病理确诊的肝脏实质性占位病变的超声造影表现。其中31例肝细胞性肝癌,23例肝血管瘤,并与常规超声、增强MRI及病理结果对照。结果:肝细胞性肝癌96.8%(30/31)表现为动脉相快速整体增强,门脉相快速廓清呈低回声改变的造影灌注特征。3.2%(1/31)门脉相及延迟相均呈等增强。肝血管瘤91.3%(21/23)表现为动脉相环状增强,门脉相缓慢向心性充填,延迟期高增强。8.7%(2/23)整体快速增强。常规超声、超声造影及增强MRI诊断肝细胞肝癌的敏感性、特异性、正确率分别为61.3%,65.2%,63.0%,96.8%,91.3%,94,4%及93.5%,95.6%,94.4%。超声造影、增强MRI同病理结果有较高的符合率(Kappa值分别为0.89,0.89),比较常规超声有显著提高(Kappa值为0.25)。结论:肝细胞性肝癌和血管瘤在超声造影中表现为不同的灌注特点,超声造影为两者的诊断及鉴别诊断提供了定性诊断技术,有较常规超声更高的临床价值。Objective： To analyze the clinical value of contrast-enhanced ultrasonography（CEUS） in the diagnosis and differential diagnosis of hepatocellular carcinoma and hepatic hemangioma combined with hepatic cirrhosis.Methods： A total of 54 cases of hepatic cirrhosis combined with either hepatocellular carcinoma（n=31） or hepatic hemangioma（n=23）,which were confirmed by pathology,were retrospectively studied.The results of conventional ultrasound,contrast-enhanced MRI,and pathological exam were compared with that of CEUS.Results： By CEUS,96.8%（30/31） hepatocellular carcinoma displayed swift enhancement in the arterial phase and swift expurgation in the portal phase,while only 3.2%（1/31） hepatocellular carcinoma was isoechoic in all phases;91.3%（21/23） hepatic hemangioma showed peripheral nodular enhancement in arterial phase and centripetal filling in portal phase and hypoenhancement in delayed phase,while only 8.7%（2/23） showed swift enhancement.The sensitivity,specificity,and accuracy rate in diagnosing hepatocellular carcinoma was respectively 61.3%,65.2%,and 63.0% by conventional ultrasound,96.8%,91.3%,and 94.4% by CEUS,and 93.5%,95.6%,and 94.4% by contrast-enhanced MRI were respectively.CEUS and contrast-enhance MRI were highly consistent with the pathological results（Kappa=0.89 and 0.89）,and their correct rate of diagnosis were significantly higher than that of conventional ultrasound（Kappa=0.25）.Conclusion： The characteristics of blood flow perfusion in hepatocellular carcinoma and hepatic hemangioma using CEUS are different.CEUS is better than conventional ultrasound in the diagnosis and differential diagnosis of hepatocellular carcinoma and hepatic hemangioma.

关 键 词：超声造影 肝硬化背景 肝细胞性肝癌 肝血管瘤 

分 类 号：R735.7[医药卫生—肿瘤]