目的：总结含脂质肝癌的超声造影表现，并与其MRI表现进行比较。方法2010年7月至2012年12月解放军第三〇二医院收治的MRI双回波序列成像提示病灶内含有脂质成分的17例肝细胞癌患者，共17个病灶。其中15例患者经增强MRI和增强CT确诊，另2例患者经手术病理证实。分析其常规超声、超声造影及增强MRI的表现。超声造影与增强MRI诊断结果的一致性采用Kappa分析进行检验。结果本组17个病灶二维超声显示9个病灶呈不均质低回声，5个病灶呈低回声；其中13个病灶边界清晰，4个病灶边界欠清晰；彩色多普勒超声观察11个病灶内部无明显血流信号，5个病灶周边可见血流信号，1个病灶可见丰富血流信号。超声造影动脉期15个病灶快速高增强，1个病灶同步等增强，1个病灶轻度增强；门脉期10个病灶廓清，1个病灶呈同步等增强，1个病灶轻度增强；延迟期16个病灶廓清，1个病灶呈等增强；其中6个病灶内存在斑片状、不规则的三期无增强区域。超声造影诊断符合率为82%（14/17），MRI诊断符合率为88%（15/17），两者一致性检验的Kappa值为0.628，超声造影与MRI诊断结果一致性较好。结论含脂质肝癌病灶内部或周边始终可见三期无增强区域；含脂质肝癌超声造影的某些特征对于诊断含脂质肝癌具有一定的参考价值。%Objective To summarize the imaging features of hepatic tumors contained lipid by contrast enhanced ultrasound (CEUS), and compare with MRI ifndings. Methods From July 2010 to December 2012, 17 patients of hepatocellular carcinoma containing lipid component in the 302nd Hospital of the People′s Liberation Army underwent dual-echo sequence MRI imaging. Fifteen patients were conifrmed by enhanced MRI and contrast-enhanced CT, while the other 2 patients were confirmed by pathology. The features of ultrasonography, CEUS and MRI were analyzed. Kappa analysis test was analyzed for the consistency of CEUS and MRI ifndings. Results In the two-dimensional ultrasound of 17 lesions, 9 were hypoechoic heterogeneous lesions, 5 were hypoechoic lesions;13 lesions with clear boundaries, 4 lesions with unclear boundaries;peripheral blood lfow signal in 5 lesions and rich blood lfow in 1 lesion were observed by color Doppler ultrasound, 11 lesions had no signiifcant blood lfow signal;15 lesions showed fast high enhancement in CEUS arterial phase, 1 lesion with synchronization enhancement, 1 lesion with mild enhancement;10 lesions showed portal clearance, 1 lesion showed an enhanced synchronization, 1 lesion with mild enhancement;16 lesions showed clearance in delay phase, 1 enhanced lesion showed isoenhancement;6 lesions presented intra-lesion or surrounding patchy, irregular non-enhancement areas. CEUS diagnostic accuracy was 82%(14/17), the diagnostic accuracy of MRI was 88%(15/17). The Kappa consistency test was 0.628, while CEUS and MRI results were in good agreement. Conclusions Performance of hepatocellular lipid-containing ultrasound contrast arterial phase shows non-enhancement areas. Contrast enhanced ultrasound features of lipid-containing hepatocellular carcinoma are valuable for the clinical diagnois.
展开▼
