超声造影在神经内分泌来源及非神经内分泌来源转移性肝癌中鉴别诊断的应用价值

摘要

目的 探讨超声造影(CEUS)在鉴别神经内分泌来源转移性肝癌(NETLM)及非神经内分泌来源转移性肝癌(NNETLM)中的应用价值.方法 对经手术或穿刺病理证实的30例NETLM及50例NNETLM患者CEUS声像图进行回顾性分析,记录并评价病灶增强时间、增强方式及在动脉期(0～40 s)、门脉期(40～120 s)、延迟期(＞120 s)各期的表现等.结果 两组转移性肝癌病灶造影后均有不同程度的增强,其中NETLM的增强减退时间(44.73±22.70)s晚于NNETLM的减退时间(33.72±7.17)s(P＜0.05);两组转移性肝癌病灶动脉期的增强方式主要为环状增强和整体增强两种,其中NETLM表现为整体增强的比例(93.3％)明显高于NNETLM (56.0％) (P＜0.05);两组转移性肝癌病灶在门脉期增强均有不同程度的减退,与周围肝实质回声相比,分为轻度减退和明显减退两种;其中NETLM表现为轻度减退的比例(30.0％)明显高于NNETLM(4.0％)(P＜0.05).结论 NETLM和NNETLM的CEUS表现有一定差异性,CEUS在对二者的鉴别诊断中有一定价值.%Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in differentiation between liver metastases from neuroendocrine tumors(NETLM) and liver metastases from non-neuroendocrine tumors (NNETLM).Methods A total of 30 cases with NETLM and 50 cases with NNETLM were retrospectively studied with CEUS.The dynamic enhancement features,including enhancement time,enhancement pattern and washout pattern were observed.Results After injecting contrast agent,two groups of liver metastases lesions were variously enhanced on CEUS.The time of reducing enhancement (44.73±22.70) s in NETLM was later than that(33.72 ± 7.17) s in NNETLM (P＜0.05).Two patterns of enhancement were observed during the arterial phase:global enhancement and rim-like enhancement.NETLM had a significantly higher proportion(93.3％) of global enhancement than that (56.0％) of NNETLM (P＜0.05).These two groups lesions showed mild washout or remarkable washout in portal phase compared with liver parenchyma.NETLM had a significantly higher proportion(30.0％) of mild washout than that (4.0％) of NNETLM (P＜0.05).Conclusions CEUS is useful for the differential diagnosis of NETLM and NNETLM.