手术证实的肝脏局灶性结节增生超声造影特征与大小的关系  

Contrast-enhanced ultrasound features of surgically confirmed liver focal nodular hyperplasia in correlation with lesion size

作　　者：张炜彬 王文平 董怡 汪瀚韬 徐亚丹 曹佳颖 ZHANG Wei-bin;WANG Wen-ping;DONG Yi;WANG Han-tao;XU Ya-dan;CAO Jia-ying(Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院超声科,上海200032

出　　处：《复旦学报（医学版）》2021年第4期463-468,共6页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(82071942);上海市临床重点专科项目(shslczdzk03501)。

摘　　要：目的研究肝脏局灶性结节增生(focal nodular hyperplasia,FNH)超声造影(contrast enhanced ultrasound,CEUS)的典型征象,及其与病灶大小及脂肪肝背景的关系。方法回顾性分析2017年10月-2019年12月复旦大学附属中山医院经手术切除病理证实的51例FNH患者的CEUS表现,并分析FNH增强表现在不同大小的3组(<3 cm组,3~5 cm组,>5 cm组)及不同肝背景的2组(脂肪肝组,正常肝组)中的差异。结果注射造影剂后,FNH病灶在动脉期均表现为快速高增强(100%),其中41.2%(21/51)表现为泉涌状增强,29.4%(15/51)表现为轮辐状增强;21.6%(11/51)表现为分枝状增强;7.8%(4/51)表现为整体增强。中央瘢痕检出率为31.4%(16/51),滋养动脉检出率为74.5%(38/51),96.1%(49/51)表现为“快进慢出”或“快进同出”,仅3.9%(2/51)表现为“快进快出”。以上表现中,泉涌状增强在<3 cm的FNH病灶中检出率上升至71.4%(15/21);分枝状增强在>5 cm的FNH病灶中检出率上升至50%(5/10);中央瘢痕在>5 cm的FNH病灶中检出率上升至60%(6/10),即上述表现在3组病灶大小分组中检出率差异有统计学意义(Fisher精确检验,P均<0.05)。另外,FNH在2组不同肝背景分组中的CEUS表现差异均无统计学意义(Fisher精确检验及χ^(2)检验)。结论CEUS所示FNH典型征象包括泉涌征、轮辐征、中央瘢痕及滋养动脉,其中泉涌征对于病灶较小的FNH(<3 cm)更具有诊断价值,而中央瘢痕对于病灶较大的FNH(>5 cm)更具有诊断价值,脂肪肝背景不会影响其检出率。Objective To assess the typical contrast enhanced ultrasound(CEUS)enhancement characters of hepatic focal nodular hyperplasia(FNH),and to analyze the correlation with lesion size and fatty liver background.Methods We retrospectively assessed CEUS characteristics in 51 cases of FNH pathologically confirmed after surgical resection during Oct 2017 to Dec 2019,and analyzed the differences in 3 groups with different lesion sizes(<3 cm,3-5 cm,>5 cm)and 2 groups with different liver background(fatty liver,normal liver).Results All FNH lesions displayed a rapid hyper-enhancement in arterial phase of CEUS.During the arterial phase,41.2%(21/51)lesions showed gushing-spring enhancement;29.4%(15/51)showed spoke-like enhancement;21.6%(11/51)showed dendritic enhancement;7.8%(4/51)showed whole enhancement.The detection rate of central scar was 31.4%(16/51).The appearance rate of feeding arteries was 74.5%(38/51).According to echogenicity shift of the lesions in various phases,96.1%(49/51)FNH showed“fast-in and slow-out”or“fast-in and synchronous-out”,and only 3.9%(2/51)showed“fast-in and fast-out”.In the above performances,the detection rate of gushing-spring enhancement increased to 71.4%(15/21)in lesions<3 cm,that of dendritic enhancement increased to 50%(5/10)in lesions>5 cm,and that of central scar increased to 60%(6/10)in lesions>5 cm.Significant difference was found in those performance in different size groups(Fisher’s exact test,P<0.05).In addition,performance on CEUS showed no significant difference in different liver background groups(Fisher’s exact test orχ^(2) test).Conclusion The characteristic signs of FNH at CEUS include gushing-spring sign,spoke-wheel sign,central scar and feeding artery.Gushing-spring sign is more valuable for diagnosing small size FNH(<3 cm),while central scar is useful for diagnosing larger FNH lesion(>5 cm).

关 键 词：超声造影(CEUS) 局灶性结节增生(FNH) 肝脏 

分 类 号：R445.1[医药卫生—影像医学与核医学]