摘要
目的探讨超声造影后即刻基波超声对改善肝病灶特征显示的作用。方法应用SonoVue行谐波超声造影检查（CEUS）。前瞻性比较105例129个肝局灶性病变的造影前基波（Pre-CEUS）和造影结束后3min内即刻基波（Post-CEUS）的图像特征。病灶包括62个肝细胞癌（hepatocellular carcinoma,HCC）,29个肝转移癌（metestatic liver carcinoma,MLC）,32个血管瘤,4个局灶性结节增生（focal nodular hyperplasia,FNH）,2个肝包虫病灶。声像图评价包括肿瘤大小、形态、边界、内部回声、结构以及后方回声等特征变化。最后比较应用Post-CEUS前后诊断率的改变。结果与Pre-CEUS比较,Post-CEUS产生的“爆破成像”现象明显改善了图像特征的显示。对62个HCC病灶,Post-CEUS改善肿瘤边界显示,边界清晰者增加（59灶对37灶,P〈0.001）,“晕征”增加（36灶对23灶,P=0.031）;改善内部结构显示,瘤内结构不均者增多（39灶对26灶）,其中16灶（25.8%）内部新显示镶嵌征或结中结征;Post-CEUS还使后方回声增强者增多（30灶对19灶,P=0.034）。对29个MLC病灶,Post-CEUS改善肿瘤边界显示,边界清晰者增加（28灶对19灶,P=0.003）。对32个肝血管瘤病灶,Post-CEUS改善边界及内部结构显示,边界清晰者增加（31灶对24灶,P=0.026）,其中13灶（40.6%）新出现强回声边,4灶新出现内部筛孔征。2个肝包虫病灶Post-CEUS新发现多发微小囊及小钙化点。4个FNH中2个显示瘤内瘢痕样结构而Pre-CEUS仅显示1个。Pre-CEUS的诊断正确率为52.7%（68/129灶）,CEUS为86.0%（111/129灶）,CEUS结合Post-CEUS诊断率达93.0%（120/129灶）。结论高机械指数基波超声使残留造影剂产生的“爆破成像”可明显改善肝局灶病变内部结构及边界特征的显示,有助于提高CEUS的诊断率。
Objective To compare the imaging findings of high mechanical index（MI） pre- and post- contrast enhanced ultrasound （CEUS） for focal liver lesions,and evaluate the role of post CEUS in characterizing liver lesions. Methods One hundred and twenty nine focal liver lesions,including 62 hepatocellular carcinomata （HCC） ,29 hepatic metastases,32 hemangiomas,4 focal nodular hyperplasias（FNH） and 2 hepatic echinococcosis were included in the study. Each lesion was scanned with low-Ml CEUS with SonoVue as the contrast agent. High MI conventional ultrasonography was performed before and right after CEUS. Findings of per- and post-CEUS were analyzed by two blinded reading sonologist to evaluate for size, boundary, echogenicity, internal texture, posterior acoustic enhancement. Diagnostic accuracy rate of pre-CEUS, CEUS and post-CEUS were compared based on final results. Results Of the 62 HCCs examinations,post-CEUS displayed better for margin definition （ P 〈0. 001 ）,halo sign （ P = 0. 031 ）,internal texture （ P = 0. 019）. Post-CEUS clearly showed ＂halo＂ sign in 13 more lesions and ＂mosaic＂ or ＂nodule in nodule＂ signs in 16 more lesions compared with pre-CEUS. Of the 29 hepatic metastases imaging, post-CEUS showed better-defined margin （ P = 0. 003）. Of the 32 hemangiomas imaging, post-CEUS showed improved visibility for margin definition （ P = 0. 026）. Post CEUS clearly depict echogenic rim in 13 more lesions and inner granular hypo-echo in 4 more lesions. Multiple vesicles and calcification spots were demonstrated in both 2 hepatic alveolar echinococcosis by post-CEUS but not found by pre-CEUS. Post-CEUS found central scar structure in two of 4 FNHs but pre-CEUS detected only one. In the end with pathological and clinical evidence, the diagnostic accuracy rate of pre-CEUS was 52.7% （68/129 lesions）, lower thanthat of CEUS （ 86. 0 % , 111 / 129 lesions ） , with the complementation of post - CEUS the rate rose to 93.0 （120/129 lesions）. Conclusions Post-CEUS can improve the visibility of typical structures of focal liver lesions compared with pre-CEUS,and provide important complementary information for CEUS.
出处
《中华超声影像学杂志》
CSCD
2007年第7期593-598,共6页
Chinese Journal of Ultrasonography
基金
北京市科委重大项目培育专项基金（Z0005190040431）
关键词
超声检查
造影剂
肝疾病
Ultrasonography
Contrast media
Liver diseases
