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目的:分析在肝硬化背景下超声造影对肝细胞性肝癌及肝血管瘤的诊断及鉴别诊断。方法:回顾性分析54例均经临床诊断为肝硬化并病理确诊的肝脏实质性占位病变的超声造影表现。其中31例肝细胞性肝癌,23例肝血管瘤,并与常规超声、增强MRI及病理结果对照。结果:肝细胞性肝癌96.8%(30/31)表现为动脉相快速整体增强,门脉相快速廓清呈低回声改变的造影灌注特征。3.2%(1/31)门脉相及延迟相均呈等增强。肝血管瘤91.3%(21/23)表现为动脉相环状增强,门脉相缓慢向心性充填,延迟期高增强。8.7%(2/23)整体快速增强。常规超声、超声造影及增强MRI诊断肝细胞肝癌的敏感性、特异性、正确率分别为61.3%,65.2%,63.0%,96.8%,91.3%,94,4%及93.5%,95.6%,94.4%。超声造影、增强MRI同病理结果有较高的符合率(Kappa值分别为0.89,0.89),比较常规超声有显著提高(Kappa值为0.25)。结论:肝细胞性肝癌和血管瘤在超声造影中表现为不同的灌注特点,超声造影为两者的诊断及鉴别诊断提供了定性诊断技术,有较常规超声更高的临床价值。
Objective: To analyze the diagnosis and differential diagnosis of hepatocellular carcinoma and hepatic hemangioma with contrast-enhanced ultrasound in cirrhosis. Methods: A retrospective analysis of 54 cases of liver cirrhosis by pathological diagnosis and pathological diagnosis of substantial liver lesions showed by contrast-enhanced ultrasound. There were 31 cases of hepatocellular carcinoma and 23 cases of hepatic hemangiomas, which were compared with conventional ultrasound, enhanced MRI and pathological findings. Results: 96.8% (30/31) of hepatocellular carcinoma showed a rapid and overall enhancement of arterial phase, and the rapid debridement of portal phase showed hypoechoic contrast-enhanced perfusion imaging. 3.2% (1/31) portal phase and delayed phase were showed such as enhanced. 91.3% (21/23) of hepatic hemangiomas showed an enhancement of the arterial phase and a slow filling of the portal phase with a high delayed phase. 8.7% (2/23) overall rapid growth. The sensitivity, specificity and accuracy of conventional ultrasound, contrast-enhanced ultrasound and enhanced MRI in diagnosing hepatocellular carcinoma were 61.3%, 65.2%, 63.0%, 96.8%, 91.3%, 94.4%, 93.5%, 95.6%, 94.4 %. Contrast-enhanced ultrasound and MRI enhanced the coincidence rate with the pathological results (Kappa values were 0.89,0.89, respectively), and were significantly higher than those with conventional ultrasound (Kappa value 0.25). Conclusion: Hepatic hepatocellular carcinoma and hemangiomas show different perfusion characteristics in contrast-enhanced ultrasound. Contrast-enhanced ultrasound can provide qualitative diagnosis for both diagnosis and differential diagnosis, which has higher clinical value than conventional ultrasound.