超声造影在≤3 cm肝细胞癌及肝局灶性结节增生鉴别诊断中的应用  

Application of contrast-enhanced ultrasound in differential diagnosis of≤3 cm hepatocellular carcinoma and focal nodular hyperplasia of the liver

作　　者：袁愷 季正标 毛枫 张炜彬 袁海霞 王文平 YUAN Kai;JI Zhengbiao;MAO Feng;ZHANG Weibin;YUAN Haixia;WANG Wenping(Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai 200032,China;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诊断科,上海200032 [2]上海市影像医学研究所,上海200032

出　　处：《中国临床医学》2024年第6期945-950,共6页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(82272013);上海申康中心重大临床研究项目(SHDC2020CR1031B);上海市临床重点专科项目(shslczdzk03501).

摘　　要：目的探讨超声造影(contrast-enhanced ultrasound,CEUS)在最大径≤3cm的肝细胞癌(hepatocellular carcinoma,HCC)与肝局灶性结节增生(focal nodular hyperplasia,FNH)鉴别诊断中的价值。方法回顾性分析经病理检查证实的48例肿瘤最大径≤3 cm的HCC及48例肿瘤最大径≤3 cm的FNH患者的CEUS图像。对比两组病灶的CEUS时相变化、增强模式及增强特征。结果两组病灶均在动脉期高回声增强,HCC组与FNH组分别在17(15,19)s、15(12,18.75)s开始增强(P=0.017);两组增强达峰时间差异无统计学意义[22(19,26)s vs 21(17,25)s]。HCC组及FNH组在动脉期的主要增强方式分别是整体增强、离心性增强。HCC组表现为整体增强的病灶占比明显高于FNH组(100%vs 2.08%,P<0.05);FNH组表现为离心性增强的病灶占比高于HCC组(97.91%vs 0,P<0.05)。在整个CEUS过程中,HCC组表现为“快进快出”的病灶占比高于FNH组(87.50%vs 8.33%,P<0.05),FNH表现为“快进同出”/“快进慢出”的病灶占比高于HCC组(91.67%vs 12.50%,P<0.05)。结论CEUS能鉴别≤3 cm的HCC和FNH。Objective To investigate the diagnosis value of contrast-enhanced ultrasound(CEUS)in the differentiation of hepatocellular carcinoma(HCC)and focal nodular hyperplasia(FNH)of the liver with≤3 cm of maximum diameter.Methods The image characteristics in 48 lesions of HCC with maximum diameter≤3 cm and 48 lesions of FNH with maximum diameter≤3 cm confirmed by pathology were retrospectively analyzed.The phase changes,enhancement patterns and enhancement characteristics of the lesions in the two groups were compared.Results All lesions in the two groups showed high-echo in the arterial phase.The contrast arrival time in HCC group and FNH group was 17(15,19)s and 15(12,18.75)s(P=0.017);the peak time in the two groups was 21(17,25)s and 22(19,26)s(P>0.05).The main enhancement patterns of HCC group and FNH group in arterial phase were homogeneous enhancement and centrifugal enhancement,respectively.All HCC lesions showed homogeneous enhancement,which was significantly higher than FNH(2.08%,P<0.05);97.91%of FHN lesions showed centrifugal enhancement,which was higher that of HCC lesions(0,P<0.05).During the CEUS process,87.5%of HCC lesions showed“rapid fill-in and rapid wash-out”,which was significantly higher than that of FNH lesions(8.33%,P<0.05);91.67%of FNH lesions showed“rapid fill-in”and“synchronous/slow wash-out”which was significantly higher than that of HCC lesions(12.50%,P<0.05).Conclusion CEUS is helpful in the differential diagnosis of FNH and HCC with maximum diameter≤3 cm.

关 键 词：超声造影 肝细胞癌 肝局灶性结节增生 

分 类 号：R735.7[医药卫生—肿瘤]