超声造影在肝泡型包虫病与原发性肝癌鉴别诊断中的价值  

Hepatic alveolar echinococcosis and primary liver cancer: differential diagnosis with contrast-enhanced ultrasound

作　　者：闫珊玲[1] 卢强[2] 郑红[1] 李成[1] 

机构地区：[1]德阳市人民医院超声科,四川德阳618000 [2]四川大学华西医院超声科,成都610041

出　　处：《华西医学》2017年第7期1037-1041,共5页West China Medical Journal

摘　　要：目的评价超声造影对肝泡型包虫病(hepatic alveolar echinococcosis,HAE)与原发性肝癌(primary liver cancer,PLC)鉴别诊断的价值。方法 2010年1月—2015年5月收集HAE及PLC患者共56例,其中PLC患者32例,HAE患者24例。患者均行超声造影检查,分析、比较PLC及HAE的常规超声及超声造影特征,包括病灶的大小、数量、有无钙化、造影时有无增强及增强的程度及增强模式。结果两组患者性别构成和年龄差异均有统计学意义(P=0.013、0.002)。32例PLC患者共检出38个病灶,病灶直径3~10 cm,平均(5.6±2.1)cm,其中2个(5.3%)病灶内部可见钙化灶。24例HAE患者共检出32个病灶,病灶直径4~12 cm,平均(9.1±4.4)cm,其中24个(75.0%)病灶内部可见钙化灶。两组病灶大小及钙化发生率的差异均有统计学意义(P<0.001)。超声造影动脉期100.0%(38/38)PLC病灶周边均可见增强,其中84.2%(32/38)呈高增强,15.8%(6/38)动脉期周边可见枯枝状稍高增强,实质期100.0%(38/38)呈低增强。43.8%(14/32)HAE病灶周边动脉期及实质期探及不规则高增强区,56.2%(18/32)周边动脉期及实质期均未见强化,100.0%(32/32)HAE病灶内部均未见增强。两组患者在动脉期周边增强及病灶内部增强间的差异均有统计学意义(P<0.001)。结论 HAE及PLC的常规灰阶超声表现有相似性,但超声造影表现有明显差异,常规超声结合超声造影可以帮助PLC与HAE的鉴别。超声造影时肝脏占位动脉期高增强、实质期低增强要考虑PLC;当肝脏占位有明显钙化,超声造影显示占位内部无增强,周边出现或不出现不规则强化时需考虑HAE。Objective To determine the value of contrast-enhanced ultrasound （CEUS） in the differentiation of primary liver cancer （PLC） and hepatic alveolar echinococcosis （HAE）. Methods The data of 56 patients with PLC or HAE were collected between January 2010 and May 2015. Grayscale and CEUS features of the patients were analyzed retrospectively. The frequency of each imaging finding, including calcification, arterial enhancement, and internal enhancement were evaluated and compared. Results Statistically significant difference of the proportion of gender and age were detected between the two groups （P=0.013, 0.002）. Thirty-eight PLC lesions were detected in 32 patients. The diameters of PLC lesions were 3-10 cm with an average of （5.6±2.1） cm. Thirty-two HAE lesions were found in 24 patients. The diameters of HAE lesions were 4-12 cm with an average of （9.1±4.4） cm. Statistically significant difference of lesion size and the incidence rate of calcification （5.3% vs. 75.0%） were seen between PLC and HAE （P〈0.001）. Peripheral enhancement were seen in 100.0% （38/38） PLC lesions, including 84.2% （32/38） hyperenhancement and 15.8% （6/38） dendritic hyperenhancement. All PLC lesions demonstrated hypoenhancement in late phase. Irregular peripherally hyperenhancement both in arterial and late phase were detected in 43.8% （14/32） HAE lesions. The other 56.2% （18/32） HAE lesions showed no peripheral enhancement both in arterial and late phase. No internal enhancement were seen in HAE lesions. The presence of arterial enhancement （100.0% vs. 43.8%） and absence of internal enhancement （0 vs. 100.0%） were significantly different between PLC and HAE （P〈0.001）. Conclusions PLC is predicted by arterial phase hyperenhancement and late phase hypoenhancement on CEUS. HAE is predicted with calcification on baseline sonography and internal non-enhancement on CEUS. Arterial phase enhancement is less common and less intensive in HAE than in PLC which also contributes to the

关 键 词：超声 造影剂 肝癌 泡型包虫病 

分 类 号：R445.1[医药卫生—影像医学与核医学]