超声造影和微血流成像对不典型肝癌与肝局灶性结节性增生的鉴别诊断价值分析

doi:10.3969/j.issn.1672-5069.2017.04.021

摘要/Abstract

摘要： 目的探讨超声造影和微血流成像技术对不典型原发性肝癌（PLC）和肝局灶性结节性增生（FNH）病变的鉴别诊断价值。方法 2014年1月~2015年12月本院收治的不典型PLC患者35例和FNH患者40例,术前行超声造影检查和微血流成像检查,对比分析两种检查方法诊断指标的异同。结果 PLC病灶造影剂到达时间为（4.1±0.7）s,达峰时间为（37.8±11.4）s,分别显著长于FNH组的（2.5±1.0）s和（24.2±9.5）s（P<0.05）;PLC组峰值强度为（23.1±5.7）dB,明显低于FNH组的（30.6±4.3）dB（P<0.05）;35例不典型PLC患者中,病灶斑块状增强19例,环状增强16例,在40例FNH患者中,病灶动脉相离心性“轮辐状”增强29例,偏心性增强11例,门脉相均为高增强,延迟相高增强15例,等增强22例,低增强3例;在微血流成像检查方面,PLC组动脉最大血流速度（Vmax）为（64.7±3.3）v·cm^-1·s^-1,显著低于FNH组的（77.8±5.1）v·cm^-1·s^-1（P<0.05）,血流阻力指数（RI）为（0.70±0.05）,显著高于FNH组的【（0.53±0.03）,P<0.05】;在血流信号等级分布方面,不典型PLC组1级3例（8.6%）、2级19例（54.3%）、3级13例（37.1%）,FNH组0级33例（82.5%）、1级7例（17.5%）,两组差异有统计学意义（P<0.05）。结论超声造影和微血流成像技术分别能从造影的时相和增强模式及血流动力学特征上正确区分不典型PLC与FNH,具有较好的鉴别诊断价值。

关键词: 不典型原发性肝癌, 肝局灶性结节性增生, 超声造影, 微血流成像, 鉴别诊断

Abstract: Objective To explore the application of ultrasound contrast and micro blood flow imaging in differential diagnosis of atypical primary liver cancer （PLC） and focal nodular hyperplasia （FNH）. Methods 35 patients with atypical PLC and 40 with FNH were selected in our hospital between January 2014 and December 2015. All the patients underwent ultrasound contrast and micro blood flow imaging,and the features of PLC and FNH were analyzed and compared. Results The ultrasound contrast showed that the arrive time of contrast agent [（4.1±0.7） s] and the time to peak [（37.8±11.4） s] in the PLC group were significantly longer than those [（2.5±1.0） s and （24.2±9.5） s] in the FNH group,while the peak strength[（23.1±5.7） dB] was obviously lower than [（30.6±4.3） dB] in the FNH group（P<0.05）;As showed by the ultrasonogram of liver tumors in enhancement,there were 19 foci being with patchy enhancement and 16 with ring-enhancement in the PLC group,while in the FNH group,there were 29 foci being with annulare enhancement and 11 with eccentric enhancement in arterial phase,40 foci showing hyper-enhancement in portal phase,16 being with hyper-enhancement,22 with same enhancement and 3 with low-enhancement in delayed phase（P<0.05）;the results of micro blood flow imaging showed that the maximum artery blood flow velocity （Vmax） was[（64.7±3.3） v·cm^-1·s^-1] in patients with PLC, obviously lower than[（77.8±5.1） v·cm^-1·s^-1] in the FNH group,while the resistant index （RI） was [（0.70±0.05）],much higher than [（0.53±0.03）] in the FNH group （P<0.05）;There were 3 foci（8.6%） with blood signals of grade 1,19（54.3%） with that of grade 2 and 13（37.1%） with that of grade 3 in the PLC group,while there were 33 foci （82.5%） with blood signals of grade 0 and 7 （17.5%） with that of grade 1 in the FNH group （P<0.05）. Conclusion The ultrasound contrast and micro blood flow imaging could distinguish atypical PLC and FNH by the characteristics of time phase,contrast enhancement and the hemodynamic changes.

Key words: Hepatoma, Focal nodular hyperp-lasia, Ultrasound contrast, Micro blood flow imaging, Differential diagnosis

马进辉. 超声造影和微血流成像对不典型肝癌与肝局灶性结节性增生的鉴别诊断价值分析[J]. 实用肝脏病杂志, 2017, 20(4): 464-467.

Ma Jinhui.. Application of ultrasound contrast and micro blood flow imaging in differential diagnosis of atypical primary liver cancer and focal nodular hyperplasia[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(4): 464-467.

参考文献

[1] 程文,黄道中. 肝脏恶性肿瘤超声造影不典型表现及相关病理基础. 当代医学,2009,15（19）:24-25.
[2] 丁红,王文平,黄备建,等. 超声造影非典型肝癌的血流动力学表现及病理特征分析. 中华超声影像学杂志,2007,16（8）:677-680.
[3] 张悦,丁红. 肝脏局灶性结节性增生的影像学研究及临床新进展. 中华医学超声杂志电子版,2016,13（4）:245-248.
[4] 王荃荣子,刘希胜,俞同福,等. 肝脏局灶性结节增生的病理基础及影像学表现. 中国医学影像学杂志,2012,20（9）:717-720.
[5] Chaubal N,Joshi M,Bam A,et al. Contrast-enhanced ultrasound of focal Liver lesions. Semin Roentgenol,2016,51（4）:334-357.
[6] 陈卫,邓俊,顾岚,等. 肝动脉造影对常规影象学检查难于判断肝癌的诊断价值. 实用肝脏病杂志,2010,13（1）:51-52.
[7] 高莉,张丽春,史红梅. 超声造影在肝硬化背景下局灶性病变诊断的应用. 山西医药杂志,2013,42（6）:624-625.
[8] 胡永胜,朱宇,徐毅. 实时超声造影在肝脏良恶性病变鉴别诊断中的应用价值分析. 实用肝脏病杂志,2015,18（2）:197-198.
[9] 陈瀚勋,卢敏艳,舒琦,等. 超声造影在肝细胞癌和肝局灶性结节增生鉴别诊断中的价值. 中国普外基础与临床杂志,2015,22（1）:85-87.
[10] Shi H,Wang Y,Wang H,et al. Use of three-dimensional color power doppler in imaging of liver cancer. J Biol Regul Homeost Agents,2016,30（3）:801-806.
[11] 张宏春,耿喆. 增强CT扫描与超声造影对肝脏占位性病变的临床诊断价值比较. 实用肝脏病杂志,2016,19（6）:696-699.
[12] 黄永东,张振岳,毛健,等. 肝癌伴动静脉瘘的造影表现. 现代消化及介入诊疗,2012,17（4）:229-230.
[13] 司芩,钱晓莉,黄声稀,等. 原发性肝癌超声造影特征及其与病理相关性的研究. 临床肿瘤学杂志,2011,16（1）:50-53.
[14] 林志光,郑媛. 非典型局灶性原发性肝细胞癌超声造影的特点与病理对照分析. 中国医药导报,2009,6（2）:61-62.
[15] 陈敏泳,张辉,王运韬,等. 肝脏局灶性结节性增生的临床及影像学诊断. 肝胆胰外科杂志,2014,26（6）:471-474.
[16] 陈立达,王伟,刘广健,等. 肝脏局灶性结节增生的超声造影表现及相关因素. 中国医学影像技术,2013,29（9）:1473-1476.
[17] 张姝,赵洪震,兰海峰. 彩色多普勒血流显像及超声造影在肝局灶性结节增生中的诊断价值. 肝脏,2016,21（5）:344-346.
[18] 曹晖,李平新. 彩色多普勒超声检查、超声造影、增强CT诊断肝脏局灶性结节样增生的比较. 中华医学超声杂志电子版,2010,7（11）:61-63.
[19] 许玲,王龙胜,郑穗生. 原发性肝细胞肝癌血供特点的CT表现与病理对照研究. 安徽医学,2014,35（2）:160-163.
[20] 覃康朋. 不典型肝细胞癌的CT影像分析. 医学信息,2012,25（5）:120-120.
[21] 杨伟萍,曾凡剑. 肝脏局灶性结节性增生的影像学诊断研究. 中国癌症防治杂志,2011,3（1）:92-95.