超声造影在肝上皮样血管内皮瘤与原发性肝癌鉴别诊断中的研究  

Contrast-enhanced ultrasound in differential diagnosis of hepatic epithelioid hemangioendothelioma and hepatocellular carcinoma

作　　者：徐亚丹 沈海云 毛枫 张小龙 黄备建 王文平 XU Yadan;SHEN Haiyun;MAO Feng;ZHANG Xiaolong;HUANG Beijian;WANG Wenping(Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai Institute of Medical Imaging,Shanghai 200032,China)

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：《肿瘤影像学》2018年第4期274-278,共5页Oncoradiology

基　　金：国家自然科学基金项目(81371577);上海市医学领军人才项目;上海市科学与技术委员会课题(16411968400)

摘　　要：目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)在肝上皮样血管内皮瘤(hepatic epithelioid hemangioendothelioma,HEHE)与肝细胞癌(hepatocellular carcinoma,HCC)鉴别诊断中的价值。方法:分析20例HEHE患者共31个病灶和43例HCC患者共43个病灶的CEUS图像,观察病灶的增强特点。结果:31个HEHE病灶中,16个整体增强,8个树枝样增强,7个环状增强;而43个HCC病灶中,41个整体增强,1个树枝样增强,1个环状增强(P<0.05)。在增强时相上,11个HEHE病灶快于周围正常肝实质增强,20个病灶与周围正常肝实质同步增强;而41个HCC病灶快于周围正常肝实质增强,2个病灶与周围正常肝实质同步增强(P<0.05)。在增强强度达峰值时,13个HEHE病灶呈等增强,10个病灶呈高增强,8个病灶呈低增强;而38个HCC病灶呈高增强,5个呈等增强(P<0.05);23个HEHE病灶增强均匀,8个病灶增强不均匀;而27个HCC病灶增强均匀,16个增强不均匀(P>0.05)。所有病灶在门静脉期及延迟期快速减退呈低回声改变,但HEHE减退时间快于HCC(P<0.05)。结论:CEUS在HEHE与HCC鉴别诊断中具有重要的意义。Objective: To investigate the diagnosis value of contrast-enhanced ultrasound(CEUS) in the differentiation of hepatic epithelioid hemangioendothelioma(HEHE) and hepatocellular carcinoma(HCC). Methods: The image characteristics of CEUS were retrospectively analyzed in 31 HEHE lesions and 43 HCC lesions which were confirmed by pathology. Results: In the arterial phase, 16 HEHE lesions showed global enhancement, 8 branch enhancement and 7 rim-like enhancement, while 41 HCC lesions showed global enhancement, 1 branch enhancement and 1 rim-like enhancement(P<0.05). Synchronous enhancement was observed in 20 HEHE lesions on CEUS and rapid enhancement was observed in 11 lesions, while 41 HCC lesions presented rapid enhancement and 2 lesions presented synchronous enhancement(P<0.05). At peak time, compared to the normal liver parenchyma, hypoenhancement, iso-enhancement and hyper-enhancement were observed in 8, 13,10 HEHE lesions, and in 0, 5, 38 HCC lesions, respectively(P<0.05). Regarding the enhancement homogeneity, 23 HEHE lesions were homogeneous and 8 were heterogeneous while 27 HCC lesions were homogeneous and 16 were heterogeneous. All lesions displayed hypoecho in the portal venous and delayed phases. The decrease time in HEHE was shorter than HCC. Conclusion: CEUS is significantly important in the differential diagnosis of HEHE and HCC.

关 键 词：超声造影 肝上皮样血管内皮瘤 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]