肝硬化结节与小肝癌实时超声造影定量比较研究

摘要

目的 探讨超声造影在肝硬化增生结节与小肝癌鉴别诊断中的价值.方法 34例肝硬化合并小结节病灶患者行实时超声造影检查,18例20个病灶为小肝癌,16例18个病灶为增生结节,所有病例均经病理证实.观察两类病灶增强时相、类型及模式,并行定量参数比较研究.结果 ①小肝癌动脉相高增强,门脉相等或低增强,延迟相低增强较多见；肝硬化增生结节增强表现多样化,以三期等增强最多见,两者各时相增强程度比较差异有统计学意义(P＜0.05).②肝硬化结节与小肝癌多均匀增强,不均匀增强较少见,两者增强类型比较差异无统计学意义(P＞0.05).③小肝癌病灶中,11个为快进慢退型,9个为快进快退型；增生结节病灶中,1个为中晚期增强型,3个为早期延迟增强型,14个为同步增强型.④增生结节与同深度肝硬化组织各参数比较差异均无统计学意义(P ＞0.05).小肝癌与同深度肝硬化组织及增生结节比较,始增时间、达峰时间短,峰值强度高,曲线尖度大(P＜0.05).结论 超声造影对肝硬化背景下增生结节和小肝癌的鉴别诊断具有重要价值.%Objective To evaluate the diagnostic value of contrast-enhanced ultrasound(CEUS) in regenerative nodules(RNs)and small hepatocellular carcinoma(sHCC).Methods Thirty-four cases of liver cirrhosis with small nodule were examined by CEUS.Among these cases,18 cases with 20 lesions were diagnosed s HCC,16 cases with 18 lesions were diagnosed RN eventually,all the diagnoses were confirmed by pathology.Perfusion characteristic and quantitative difference of RNs and sHCC were summarized.Results ①The majority of sHCC showed hyper-enhancement during the arterial phase,iso-enhancement or hypo-enhancement during the portal phase,hypo-enhancement during the late phase.The enhanced phase and degree of RNs were diverse,most of RNs showed iso enhancement during the three phases.The enhanced phase of two groups had significant difference(P ＜0.05).②The enhancement type of RNs and sHCC had no significant difference (P ＞ 0.05).③ 11 of 20 sHCC lesions showed contrast-enhancement pattern of "fast-in and slow-out",9 lesions were "fast-in and fast-out";among 18 RNs,1 lesion enhanced during the portal phase and the late phase,it didn't enhanced during the arterial phase,3 lesions started to enhanced at the late arterial phase,14 lesions were iso-enhancement during the three phases.④Comparison of parameters of RNs and the adjacent liver parenchyma had no significant difference(P ＞0.05).Compared with the adjacent liver parenchyma or RNs,the arrival time and peak time were shorter,the peak intensity and the curve sharpness were higher in sHCC (P ＜ 0.05).Conclusions CEUS is a useful method to distinguish RNs and sHCC in liver cirrhosis.