摘要
目的:探讨实时灰阶超声造影在小肝癌诊断与鉴别诊断中的临床应用价值。
方法:采用声诺维-低声压实时灰阶超声造影新技术(CEUS)对143例188个(直径≤3cm)肝脏局灶性病变(FHLs)进行检查,分析其灌注模式和增强时相。采用目测法对28例肝局灶性病变的肝动静脉渡越时间进行分析。对62个小肝癌病灶的超声造影增强时相与其分化程度、大小、AFP表达、场位、肝脏基础疾病状态情况的相关性进行分析。
结果:本研究通过实时灰阶超声造影的灌注模式和增强时相联合诊断,其对小肝癌诊断的准确率、敏感性、特异性、阳性预测值和阴性预测值分别为92.5﹪、91.8﹪、92.9﹪、86.2﹪和95.9﹪。肝恶性局灶性病变较良性局灶性病变的肝动静脉渡越时间缩短,两组之间差异有统计学意义(P<0.01)。本研究对62个小肝癌病灶的超声造影增强时相与其分化程度、大小、AFP表达、场位、肝脏基础疾病情况的相关性进行分析,分化程度、场位和肝脏基础疾病的不同对其超声造影增强时相有影响。
结论:实时灰阶超声造影结合肝动静脉渡越时间能够对小肝癌进行早期诊断。充分考虑到小肝癌的分化程度和场位的不同对其超声造影增强时相的影响有助于提高小肝癌的诊断与鉴别诊断。但是,因本组结果受到多种因素的影响,肝脏基础疾病对小肝癌增强时相的作用有待进一步积累资料深入研究。
Objective:To discuss the clinical value of real-time gray scale contrast enhanced ultrasound in diagnosis and differential diagnosis of small hepatocellular carcinoma (SHCC).
Methods:One hundred and forty three patients with one hundred and eighty eight focal hepatic lesions (FHLs)(diameter is less than 3cm) were examined with real-time gray scale contrast enhanced ultrasound (CEUS)after an intravenous administration of SonoVue, to analyze perfusion pattern and enhancement phases of hepatic lesions on ultrasound. As a result of which, hepatic arteriovenous transit times (HAVTT) of twenty eight patients with focal hepatic lesions were analysed by use of visual examination. The relationship between contrast enhanced ultrasound manifestations of 62 SHCCs and its histopathologic grading, size, expression of AFP, field of the hepatic liver parenchyma, elementary disease of liver can also be analysized.
Results: Regarding perfusion pattern and enhancement pattern of CEUS as the ultrasonic diagnostic criterion of SHCC, the accuracy,sensitivity, speciality, positive predictive value and negative predictive value were 92.5﹪、91.8﹪、92.9﹪、86.2﹪and 95.9﹪, respectively. HAVTT was shorter in malignant focal hepatic lesion group than in benign focal hepatic lesion group (P<0.01). The study about the correlation of contrast enhanced ultrasound manifestations with histopathologic grading of 62 SHCCs, size, expression of AFP, field of the hepatic liver parenchyma, elementary disease of liver showed that histopathologic grading, field of the hepatic liver parenchyma and elementary disease of liver were related with contrast enhanced ultrasound manifestations of SHCCs.
Conclusion:CEUS combined with HAVTT can significantly improve the pre-diagnosis of SHCC. Sufficiently considering impacts on CEUS manifestations of SHCCs by histopathologic grading and field of the hepatic liver parenchyma favors diagnosis and differential diagnosis of SHCC. However, as several aspects of factors indulge in this group, the consequence of hepatic elementary disease on CEUS manifestations of SHCC asks for further data accumulation and research.
引文
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