肝脏局灶性良性病变超声造影的表现

摘要

目的总结肝脏局灶性良性病变超声造影表现特征，探讨超声造影诊断肝脏局灶性良性病变的应用价值。方法回顾性分析常规超声诊断困难的68例经病理确诊或临床随访证实的肝脏局灶性良性病变的超声造影表现。采用四格表χ2检验比较常规超声与超声造影诊断符合率。结果68例肝脏局灶性良性病变包括复杂肝囊肿7例，肝包虫2例，肝脓肿15例，肝脏局灶性结节性增生8例，肝脏血管平滑肌脂肪瘤2例,肝细胞腺瘤4例，肝内脂肪沉积不均16例，肝脏炎性假瘤12例，肝脏孤立性坏死性结节1例，肝内胆管囊腺瘤1例。68例良性病灶中，7例复杂囊肿、2例肝包虫及1例孤立性坏死性结节始终无增强。16例肝内脂肪沉积不均为等增强；8例肝脏局灶性结节性增生、2例血管平滑肌脂肪瘤为动脉期高增强，门脉期及延迟期持续增强。15例肝脓肿表现为动脉期不同程度的网格样增强，门脉期呈等增强或低增强，延迟期低增强。4例肝细胞腺瘤动脉期均为高增强，其中3例门脉期及延迟期呈等增强或高增强，1例门脉期病灶中心区退出，呈低增强。12例炎性假瘤中8例三期无增强，3例动脉期分隔状增强后迅速退出，1例表现为动脉期病灶边缘轻度强化，延迟期呈低回声。1例肝内胆管囊腺瘤实性部分动脉期高增强，门脉期延迟期呈低增强，中央可见三期无增强区。与病理诊断结果对照，常规超声诊断肝脏局灶性良性病变与病理诊断结果符合42例，误诊26例，诊断符合率为61.8%（42/68）；超声造影与病理诊断结果符合63例，误诊5例，诊断符合率为92.6%（63/68），高于常规超声，且差异有统计学意义（χ2=8.17，P＜0.01)。结论实时灰阶超声造影可提高超声检查对肝脏局灶性良性病变诊断和鉴别诊断的准确性。%Objective To summarize the contrast enhanced ultrasonographic (CEUS) features of benign focal liver lesions, on and to investigate the value of contrast enhanced ultrasound techniques in the diagnosis of benign focal liver lesion. Methods The contrast enhanced ultrasonographic performance of 68 benign focal liver lesions cases which were dififcult for routine ultrasound diagnosis and conifrmed by pathology or follow-up were retrospectively analyzed. Chi-square test of four-fold table were used to compare the diagnostic coincidence rate of conventional ultrasound and contrast-enhanced ultrasound. Results The 68 cases of benign focal liver lesions included complex cysts (n=7), liver hydatids (n=2), liver abscess (n=15), focal nodular hyperplasia (n=8), angiomyolipoma (n=2), hepatocellular adenoma (n=4), focal fat accumulation (n=16), inlfammatory pseudotumor (n=12), solitary necrotic nodule (n=1), intrahepatic biliary cystadenoma (n=1). There were no enhancement among 7 complex cysts, 2 liver hydatids and 1 solitary necrotic nodule. Isoenhancement was detected in focal fat accumulation (n=16);hypoenhancement during the arterial phase and sustained enhancement during the portal or late phase was found in focal nodular hyperplasia (n=8) and angiomyolipoma (n=2). Grid-like enhancements during the arterial phase and isoenhancement or hypoenhancement during the portal phase, and hypoenhancement during the late phase was presented in liver abscess (n=15). Hyperenhancement during the arterial phase were detected in 4 cases of hepatocellular adenoma, 3 of which showed isoenhancement or hyperenhancement during the portal and delayed phase, one case showed hypoenhancement during the portal phase. Eight cases of all the inlfammatory pseudotumor showed no enhancement during all phases;3 cases showing grid enhancement during the arterial phase and the enhancement washed out rapidly;1 case showed mild edge enhancement during the arterial phase and hypoenhancement during the delayed phase. The solid part of the intrahepatic biliary cystadenoma showed hyperenhancement during the arterial phase and hypoenhancement during the portal and late phase.The central area showed no enhancement during all phase. The coincidence rate between pathology and conventional ultrasound diagnosis was 61.8%(42/68). The coincidence rate between pathology and contrast- enhanced ultrasound diagnosis was 92.6%(63/68). The coincidence rate of contrast-enhanced ultrasound diagnostic was higher than that of conventional ultrasound, with a statistically signiifcant difference (χ2=8.17, P < 0.01). Conclusion Real-time gray-scale contrast-enhanced sonography can improve the accuracy of the diagnosis and differential diagnosis for benign focal liver lesions.