超声造影对肝局灶性结节增生和肝细胞腺瘤的诊断研究  

Study on the Diagnosis of Focal Nodular Hyperplasia of the Liver and Hepatic Cell Adenoma by Contrast-enhanced Ultrasonography

作　　者：杜启亘[1] 陈巍[1] 米香琴 周立平[1] 

机构地区：[1]黑龙江中医药大学附属第二医院彩超室,黑龙江哈尔滨150001

出　　处：《航空航天医学杂志》2015年第6期688-691,共4页Journal of Aerospace medicine

摘　　要：目的 研究是为了评价彩色多普勒超声（color Doppler ultrasound,CDUS）联合超声造影（contrast-enhanced ultrasound,CEUS）在识别和比较肝局灶性结节增生（focal nodular hyperplasia,FNH）和肝细胞腺瘤（hepatocellular adenoma,HCA）两者特征的效能。方法 于2013年~2015年入院的患有FNH（n=14）或HCA（n=4）进行常规超声检查和CEUS后经病理确诊的18例患者。两名医生在不知道病理结果 的情况下各自独立分析常规超声和CEUS图像,然后通过讨论达成共识。后续的参数评价包括病损处的CDUS或CEUS的血管分布情况,造影的增强情况等。统计分析使用独立样本t检验和Fisher精确检验。结果 彩色多普勒超声显示,FNH的特征表现为呈树枝状的丰富血流信号（57.1%,8/14）和车轮状放射的丰富血流信号（35.7%,5/14）,而HCA的血流信号较FNH稍少,并常常表现为被膜下的短棒状血流信号（100%,4/4）。超声造影显示FNH以边缘动脉增强为特征（8/14,57.1%）。CDUS联合CEUS正确诊断病变15例（15/18,83.3%）,然而当只使用CDUS时仅有9例（9/18,50%）诊断,有显著统计学差异（P=0.008）。结论 总之,CEUS联合CDUS可以提高FNH和HCA的诊断率。CDUS表现HCA的血流信号较FNH稍少。超声造影的动脉期和延迟期的不同表现有助于两个疾病的鉴别。Objective aim of our study was to evaluate the＇value of combining color Doppler ultrasound （CDUS） with contrast- enhanced ultrasound （CEUS） in identifying and comparing features of focal nodular hyperplasia （FNH） and hepatocellular adenoma （HCA）. Methods Eighteen patients with FNH （n = 14） or HCA （n = 4）, whose diagno- ses were later confirmed by pathology, were examined with conventional ultrasonography and CEUS between 2010 and 2013. Two doctors blinded to the pathology results independently reviewed the conventional ultrasound and CEUS images and then reached a consensus through discussion. The following parameters evaluated for all lesions included vascularity pattern on CDUS or CEUS, enhancement characteristics on CEUS and the presence of a central scar. Statistical analysis was performed with the independent sample t - test and Fisher exact test. Results On CDUS, FNH was characterized by the presence of abundant blood flow signals exhibiting dendritic （57.1% ,8/14） and spoke -wheel （35.7% ,5/14） patterns, whereas blood flow signal of HCA was slightly less than FNH and often showed subcapsular short rod - like （100%, 4/4） appearance. On CEUS, the most common arterial enhancement pattern was centrifugal enhancement in FNH （8/14,57. 1% ）. A total of 15 （15/18,83. 3% ） lesions were correctly assessed using CDUS in combination with CEUS, whereas the number decreased to 9 （9/18,50%） when CDUS was used alone （P -- 0. 008）. Conclusions In conclusion, CEUS in combination with CDUS improve the diagnostic performance of FNH and HCA. Blood signal of HCA was less than FNH on CDUS. The differences of enhancement pattern during arterial phase and echogenicity during de- layed phase may contribute to the differentiation of these lesions.

关 键 词：肝局灶性结节增生 肝细胞腺瘤 超声造影 彩色多普勒超声 肝局灶性病变 

分 类 号：R445.1[医药卫生—影像医学与核医学]