超声造影诊断原发性小肝癌与肝硬化再生结节的价值  

Values of contrast-enhanced ultrasound in the diagnosis of primary small hepatocellular carcinoma and regenerative nodule in cirrhosis

作　　者：周小英[1] 杨晓霞[2] 叶春媚[1] 

机构地区：[1]深圳市宝安区人民医院超声科,广东深圳518000 [2]深圳市宝安区西乡人民医院桃源居社康中心超声部,广东深圳518000

出　　处：《中国肝脏病杂志（电子版）》2016年第2期24-28,共5页Chinese Journal of Liver Diseases：Electronic Version

基　　金：深圳市宝安区卫生公益性科研项目(2015120)

摘　　要：目的探讨超声造影诊断原发性小肝癌与肝硬化再生结节的价值。方法将2014年3月至2015年3月本院收治的经手术或肝脏活组织检查等病理明确诊断为肝硬化增生结节的23例患者（32个病灶）和诊断为原发性小肝癌的25例患者（30个病灶）作为研究对象。所有患者均实施超声造影检查,观察患者动脉相、门脉相和实质相的动态造影变化,总结不同性质病变的造影特点。结果原发性小肝癌的内部结节数量较少,多为单发,病灶与正常组织间界限清楚,边缘处较为整齐,回声除小部分不均匀外,其余皆比较均匀,其形状表现为圆形或类圆形。肝硬化结节周边呈现网格状增高趋势,回声细小整齐,结节病灶和正常组织边界清楚,在中间有类似正常肝组织的回声,可见小血管结构。原发性小肝癌和肝硬化再生结节造影后的诊断符合率均显著高于造影前（χ~2=75.8621,P=0.0000）;原发性小肝癌的峰值强度显著高于肝硬化再生结节（t=17.3855,P=0.0000）,二者造影剂到达时间无显著差异（t=1.6645,P=0.1028）;原发性小肝癌组的造影剂达峰时间较肝硬化再生结节组显著缩短（t=2.5549,P=0.0140）。结论超声造影可以提高肝硬化背景下小肝癌和肝硬化再生结节病灶定性诊断符合率,在小肝癌和肝硬化再生结节的鉴别和诊断中具有重要价值,可为临床早期诊断和鉴别提供参考。Objective To discuss the values of contrast-enhanced ultrasound in the diagnosis of primary small hepatocellular carcinoma and regenerative nodule in cirrhosis. Methods Total of 23 cases with cirrhosis regenerative nodules（32 lesions） who were diagnosed by surgery or liver biopsy and 25 cases of patients（30 lesions） who were diagnosed with primary small hepatocellular carcinoma from March 2014 to March 2015 in our hospital were selected as the study objects. All patients were given ultrasound imaging examination, the changes of arterial phase, portal phase and parenchymal phase were observed and the characteristics of the lesions were summed up. Results The number of internal nodules of primary small hepatocellular carcinoma was less and most were single. The boundary between the lesion and normal tissue was clear, the edge was more neat, except that some small parts of echo were not well-distributed, the rest were more welldistributed, and the shape was round or quasi-round. The periphery of cirrhosis nodules represented the grid increasing tendency, the echo was small and neat, the nodular lesions and normal tissue boundaries were clear and were in the middle, and an echo similar to normal liver tissue and a small vascular structure were found. The coincidence rate of the diagnosis of primary small hepatocellular carcinoma and liver cirrhosis after regeneration of the nodules were significantly higher than those of the pre-imaging（χ~2 = 75.8621, P = 0.0000）. The peak intensity of primary small hepatocellular carcinoma was significantly stronger than that of liver cirrhosis nodules（t = 17.3855, P = 0.0000）, and no significant difference was found in the arrival time of the two contrast agents（t = 1.6645, P = 0.1028）. The peak time of the contrast agent of the primary small hepatocellular carcinoma was significantly shorter than that of the cirrhosis regenerated nodules（t = 2.5549, P = 0.0140）. Conclusions Ultrasound contrast can improve the diagnostic accordance rate of small hepatocellu

关 键 词：超声造影 小肝癌 肝硬化 诊断价值 

分 类 号：R735.7[医药卫生—肿瘤] R575.2[医药卫生—临床医学] R445.1