目的 评价超声造影延迟相全肝扫查联合再次造影对肝脏恶性肿瘤检出的价值.方法 对行肝脏超声造影检查的22例肝脏恶性肿瘤患者采用低机械指数实时连续成像技术(造影剂SonoVue),延迟相进行全肝快速扫查寻找异常低增强区.并再次注射造影剂对延迟相发现的异常低增强区进行观察,超声造影诊断结果以增强CT/MRI、穿刺或手术病理诊断、临床及超声随访结果为参照,计算B型超声、超声造影发现病灶个数,计算并对比两种方法对疾病诊断的漏诊率.结果 采用延迟相全肝扫查联合再次注射SonoVue后,22例患者中,超声造影诊断肝转移瘤4例,B型超声仅诊断2例、漏诊2例;超声造影诊断肝癌或肝癌复发18例,B型超声拟诊14例,漏诊4例.超声造影对22例患者疾病漏诊率为0(0/22),B型超声漏诊率27%(6/22),二者差异有统计学意义(P<0.05).B型超声发现病灶18个,超声造影检出病变47个,超声造影延迟相新发现病灶29个.结论 延迟相全肝扫查联合再次注射造影剂可提高肝脏恶性病变的检出率,减少疾病漏诊率,值得在临床工作中推广.%To explore the value of scanning whole liver during delayed phase combined with re-injection of SonoVue to find liver malignant tumors. Methods SonoVue was injected in 22 patients with liver focal lesions, and contrast-enhanced ultrasound( CEUS ) was performed, whole liver was scanned to find abnormal enhanced lesions during delayed phase, whose thorough enhanced information was obtained by re-injection of SonoVue. By considering CT/MRI, pathology obtained by biopsy or surgery, clinical follow-up as reference standards, the numbers of focal liver lesions found by conventional ultrasound and CEUS were recorded, respectively, the rates of the missed diagnosis among these cases examined by these two ultrasound protocols were calculated. Results In 22 cases, 4 cases of metastasis were diagnosed by CEUS, only 2 cases were diagnosed by routine ultrasound. Eighteen cases of HCC or recurrence of HCC were diagnosed by CEUS, only 14 cases were diagnosed by routine ultrasound. In the 22 cases, rate of missed diagnosis on CEUS and routine ultrasound was 0( 0/22 )and 27% ( 6/22 ), respectively. The difference between them was statistical significance( P<0. 05 ). Eighteen lesions were found by routine ultrasound, 47 lesions were detected by CEUS, more 29 lesions were detected by CEUS than conventional ultrasound. Conclusion Scanning whole liver at delayed phase combined with re-injection of SonoVue has high value in detecting liver malignant tumor and decreasing the rate of missed diagnosis of liver lesions.
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