肝脏转移性神经内分泌肿瘤的超声造影诊断研究  

Study on the diagnosis of metastatic hepatic neuroendocrine neoplasms by contrast-enhanced ultrasound

作　　者：汪瀚韬 王文平 张小龙 徐亚丹 韩红 毛枫 

机构地区：[1]复旦大学附属中山医院超声科上海市影像医学研究所,上海200032

出　　处：《中华超声影像学杂志》2017年第10期872-876,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目（81371577,81571676）;上海市医学领军人才项目

摘　　要：目的分析肝脏转移性神经内分泌肿瘤（metastatic hepatic neuroendocrine neoplasm，MHNEN）的超声造影表现，探讨超声造影对MHNEN的诊断价值。方法回顾性分析28例病理诊断为MHNEN的病例，观察肿瘤常规超声表现，超声造影增强时相、增强模式、增强强度等特点。结果对28例患者的35个病灶进行超声造影，开始增强时间为（15．96±4．14）s，达峰时间为（21．42±5．01）s，表现为等回声时间为（29．41±4．83）s，出现低回声时间为（42．06±22．84）S。其中开始增强时间早于肝实质的病灶占42．9％（15／35），与肝实质同步增强的病灶占48．6％（17／35），晚于肝实质增强的病灶占8．5％（3／35）。增强达峰值时。82．9％（29／35）的病灶呈整体增强，17．1％（6／35）的病灶呈环状增强。另外，22．9％（8／35）的病灶在增强过程中表现出向心性填充的特征。所有病灶峰值强度均高于肝实质，门脉期病灶增强减退，31．4％（11／35）的病灶表现为稍低回声，68．6％（24／35）的病灶表现为低回声，延迟期所有病灶均呈低回声改变。超声造影比常规超声多发现36个病灶，超声造影后所有病灶边界较常规超声显示更加清晰。结论MHNEN的超声造影表现具有一定的特征性，超声造影对MHNEN的诊断有一定价值。Objective To retrospectively analyze the contrast-enhanced ultrasound （CEUS） features of metastatic hepatic neuroendocrine neoplasm （MHNEN） and their diagnostic value. Methods Twentyeight patients with 35 MHNEN lesions were enrolled in this retrospectively study and underwent CEUS examination. The dynamic enhancement features, including enhancement pattern, peak intensity, and washout pattern were analyzed. Results The arrival time of contrast agent, time to peak, time to iso- echogenityand time to hypo-echogenity was （15.96 ± 4.14）s, （21.42 ± 5.01）s, （29.41 ± 4.83）s and （42.06 ± 22.84）s, respectively. Compared with adjacent liver parenchyma, rapid enhancement, synchronous enhancement and slow enhancement were found in 42.9% （15/35）, 48.6% （17/35）, 8.5%（3/35） of MHNEN lesions, respectively. As for enhancement patterns, 82.9% （29/35） of MHNEN lesions showed global enhancement, while 17.1 % （6/35） showed rim-like enhancement. In addition, 22.9 %（8/35） of the selesions had a centripetal pattern during the arterial phase. Compared with liver parenchyma, all lesions demonstrated hyper-enhancement at peak enhancement. In portal venous phase, 68.6% （24/35） of MHNEN lesions presented marked hypo-enhancement and 31.4 % （11/35） with slight hypo enhancement. And in late phase, all the lesions showed marked hypo enhancement. Moreover, the boundaries of the lesions became distinct after contrast injection and another 36 lesions were identified on CEUS compared with conventional ultrasound. Conclusions CEUS can afford more diagnostic information of MHNEN and may be a good technique for diagnosing MHNEN.

关 键 词：超声造影 肝肿瘤 神经内分泌肿瘤 肿瘤转移 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]