超声造影在肝内胆管细胞癌诊断中的应用价值  

Clinical application of contrast-enhanced ultrasound in the diagnosis of cholangiocarcinoma

作　　者：李志艳[1] 汤雨[1] 李勇武[1] 刘阳[1] 周一鸣[1] 董晓宇[1] 

机构地区：[1]解放军第三0二医院超声科,北京100039

出　　处：《中华超声影像学杂志》2016年第10期870-874,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81471680）

摘　　要：目的应用常规超声及超声造影观察肝内胆管细胞癌（intrahepatic cholangiocarcinoma，ICC）的特征性表现，探讨超声造影诊断ICC的临床应用价值。方法回顾性分析我院经病理证实为ICC的患者37例，对照病理类型分析病灶位置、范围、回声、血流等声像图特征以及超声造影灌注模式、各时相的特征性表现。结果37例患者中HBsAg（＋）者占56．76％（21／37）。超声检查显示32例（88．89％）低回声病灶，病理均为中或低分化者，5例（11．12％）高回声病灶对应病理均为高分化}27例（72．97％）边界模糊，10例（27．03％）边界清晰。彩色多普勒显示59．46％（22／37）病灶为无血供，余40．54％（15／37）内测及少许血流信号。超声造影于动脉期环状增强19例（51，35％），整体条片状高增强6例（16．22％），无强化12例（32．43％）。37个病灶中，25个病灶（67．57％）所在肝的叶段于动脉早期出现一过性增强，12例（32．43％）未出现一过性增强。在门脉期时，6个病灶（16．22％）内可见少许造影剂灌注，其余病灶内均未见灌注。延迟期37例病灶造影剂均为完全退出，表现为无剂灌注。结论常规超声肝内边界模糊的乏血供病灶，超声造影动脉期环状增强和动脉早期病灶所在肝的叶段出现一过性增强是诊断ICC的重要特征性指标。Objective To observe intrahepatic cholangiocarcinoma （ICC） characteristic representation using ultrasound and contrast-enhanced ultrasound （CEUS） technology, and explore its clinical application value in diagnosis of ICC. Methods Thirty-seven lesions that were pathologically confirmed for ICC were retrospectively analyzed. According to pathological types, the ultrasonographic features of these lesions were analyzed, including the location, range, echo, blood flow, and perfusion pattern under the contrast-enhanced ultrasound, and characteristic representation in different phases, so as to further study their clinical application value for diagnosis of ICC. Results Among the 37 patients, those with HBsAg（ ＋ ） accounted for 56.76% （21/37）. Ultrasound examination showed that patients with low echo lesions corresponding to middle or low differentiation in pathological types accounted for 88.89M （32/37）. The other 5 cases with hypereehoic lesions corresponding to well-differentiated accounted for 11.12% （5/37）. Lesions with fuzzy boundaries were 72.97% （27/37）, and with clear boundaries were 27.03% （10/37）. Color Doppler ultrasound showed that the lesions without blood supply accounted for 59.46% （22/37）, and with a little blood flow signal 40.54 % （15/37）. CEUS showed in the arterial phase the ring-like enhancement accounted for 51.35% （19/37）,and the whole stripped lesions with high signals accounted for 16.22% （6/37）, and lesions without reinforcement accounted for 32.43%（12/37）. Of 37 lesions, 25 （67.57%） appeared transient enhancement in the focal lobe of liver in early arterial phase. In portal vein phase, 16.22 % （6/37） cases were seen a little contrast agent perfusion in the lesions, and the remaining 86.48 % （31/37） had no perfusion. In delayed phase, all 37 cases showed contrast agents entirely exited in the lesions, which was characterized by no perfusion. Conclusions The important characteristics indexes in diagnosing ICC are lesions that app

关 键 词：超声造影 胆管上皮癌 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.8[医药卫生—诊断学]