超声造影对肝脏异型增生结节伴癌变的诊断价值

摘要

目的 探讨肝脏异型增生结节伴癌变(DN-HCC)的超声造影表现特征,提高其诊断正确性.方法 回顾性分析经病理证实的60例患者(62个病灶)的临床资料和超声造影图像,其中54个DN-HCC,8个异型增生结节(DN),并根据超声造影肝脏影像学报告及数据系统(CEUS LI-RADS)标准进行分类.结果 DN-HCC与DN的超声造影增强类型差异有统计学意义(均P<0.05).54个DN-HCC病灶在超声造影动脉期具有不同的增强类型,59.3％(32/54)呈高增强,9.3％(5/54)呈局部高增强(结中结),13.0％(7/54)呈同步等增强,18.5％(10/54)呈不均匀低增强.44.4％(24/54)DN-HCC病灶延迟期出现造影剂廓清呈低回声.8个DN病灶中,62.5％(5/8)动脉期呈等增强,25％(2/8)呈不均匀低增强,12.5％(1/8)呈高增强.DN病灶未出现延迟期造影剂廓清.根据CEUS LI-RADS(LR)诊断标准,27.8％(15/54)DN-HCC病灶诊断为LR-5级,46.3％(25/54)DN-HCC病灶诊断为LR-4级,25.9％(14/54)DN-HCC病灶和100％(8/8)DN病灶诊断为LR-3级.将动脉期高增强(包括局部高增强)或者延迟期减退(包括局部减退)作为诊断DN-HCC标准,其敏感性为83.3％,特异性为87.5％,准确性为83.9％.结论 动脉期高增强或者延迟期减退的超声造影表现特征对诊断DN-HCC有一定价值.%Objective To investigate the imaging features of dysplastic nodules with a focus of hepatocellular carcinoma ( DN-HCC ) on contrast-enhanced ultrasound ( CEUS ) and to improve the diagnostic accuracy . Methods The clinical data of 60 patients and CEUS imaging of 62 hepatic nodules [DN-HCCs , n =54 ;dysplastic nodules (DN) , n =8] pathologically proved were reviewed retrospectively . According to Contrast Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) , the lesions were categorized . Results Significantly different CEUS patterns between DN-HCCs and DNs were observed ( P < 0 .05) . During the arterial phase ,54 DN-HCC lesions showed various enhancement patterns [ hypervascular ,59 .3％ ( 32/54 ) ;nodule-in-nodule ,9 .3％ ( 5/54 ) ;isovascular ,13 .0％ ( 7/54 ) and hypovascular ,18 .5％ (10/54)] . Of the 54 DN-HCC lesions ,44 .4％ (24/54) showed washout during the late phase .Of the 8 DN lesions ,62 .5％ (5/8) showed iso-enhancement during the arterial phase ,25％ (2/8) showed hypo-enhancement ,and 12 .5％ (1/8) showed hyper-enhancement . No DN lesion showed washout during the late phase .According to CEUS LI-RADS (LR) algorithm ,27 .8％ (15/54) DN-HCCs were LR-5 ,46 .3％ (25/54) DN-HCCs were LR-4 ,25 .9％ (14/54) DN-HCCs and 100％ (8/8) DNs were LR-3 . Regarding hyper-enhancement ( including local hyper-enhancement ) during the arterial phase or hypo-enhancement (including local hypo-enhancement) during the late phase as the diagnostic standard of DN-HCC , the diagnostic sensitivity , specificity and accuracy value were 83 .3％ , 87 .5％ and 83 .9％ , respectively . Conclusions The imaging features of hyper-enhancement during the arterial phase or hypo-enhancement during the late phase on CEUS are useful to diagnose DN-HCCs .