CT灌注成像联合彩色多普勒超声造影辨别肝脏结节性病变性质临床价值探讨*

doi:10.3969/j.issn.1672-5069.2020.01.029

摘要/Abstract

摘要： 目的探讨应用CT灌注成像联合彩色多普勒超声造影在鉴别肝脏结节性病变性质方面的临床价值。方法 2016年1月～2018年12月我院收治的肝脏结节性病变患者50例,使用CT灌注成像联合彩色多普勒超声造影检查,计算肝动脉灌注量(HAP)、门静脉灌注量(HPP)、总肝灌注量(TLP)和肝动脉灌注指数(HAPI),记录不同病灶超声造影开始增强时间、达峰时间和开始消退时间。结果肝血管瘤HAP为(0.7±0.2)mL·min^-1·mL^-1,与肝细胞癌和肝转移瘤比,差异显著【分别为(0.4±0.2)mL·min^-1·mL^-1和(0.3±0.2)mL·min^-1·mL^-1,P＜0.05】,HPP为(0.6±0.2)mL·min^-1·mL^-1,与肝细胞癌和肝转移瘤比,差异显著【分别为(0.2±0.1)mL·min^-1·mL^-1和(0.4±0.1)mL·min^-1·mL^-1,P＜0.05】, TLP为(1.4±0.4)mL·min^-1·mL^-1,与肝细胞癌和肝转移瘤比,差异显著【(0.7±0.3)mL·min^-1·mL^-1和(0.8±0.4)mL·min^-1·mL^-1,P＜0.05】,而肝细胞癌HAPI为(0.7±0.2)mL·min^-1·mL^-1,与肝转移瘤和肝血管瘤比,差异显著【分别为(0.4±0.1)mL·min^-1·mL^-1和(0.5±0.2)mL·min^-1·mL^-1,P＜0.05】;肝细胞癌动脉期病灶均呈环状高回声增强、延迟期均为低回声、造影模式呈“快进快出”,肝转移瘤动脉期多呈均匀增强、门脉期偶见弥漫增强、延迟期多为低回声,造影模式呈“快进快出”,而肝血管瘤动脉期多呈周边环形缓慢增强、门脉期偶见向心增强、延迟期多呈等回声,造影模式呈“慢进慢退”;超声造影肝细胞癌增强时间为(13.2±4.0)s,与肝转移瘤和肝血管瘤的(15.6±2.4)s和(18.7±3.2)s比,差异显著(P＜0.05),肝细胞癌达峰时间为(19.2±3.4)s,与肝转移瘤和肝血管瘤的(28.3±5.9)s和(67.3±24.2)s比,差异显著(P＜0.05),而肝血管瘤开始消退时间为(307.4±75.6)s,与肝细胞癌和肝转移瘤的(39.1±4.2)s和(35.4±6.8)s比,差异显著(P＜0.05)。结论 CT灌注成像联合彩色多普勒超声造影诊断肝脏结节性病变安全无创、方便快捷、应用价值高,能为肝脏结节性病变的鉴别诊断提供依据。

关键词: 肝脏结节性病变, 肝细胞癌, CT灌注成像, 超声造影, 诊断

Abstract: Objective To explore the clinical value of CT perfusion imaging combined with color Doppler sonography in the diagnosis of hepatic nodular lesions. Methods 50 patients with liver nodular lesions were admitted to our hospital between January 2016 and December 2018, and underwent CT and sonography. The hepatic artery perfusion (HAP),portal vein perfusion (HPP), total hepatic perfusion (TLP) and hepatic arterial perfusion index (HAPI) were measured, and the contrast enhancement time, peak time, and initial regression time of different lesions were recorded. Results The HAP of hepatic hemangioma was (0.7±0.2) mL·min^-1·mL^-1, much greater than (0.4±0.2)mL·min^-1·mL^-1 of hepatocellular carcinoma and (0.3±0.2)mL·min^-1·mL^-1 of hepatic metastases (P<0.05), the HPP was (0.6±0.2)mL·min^-1·mL^-1 , much greater than (0.2±0.1) mL·min^-1·mL^-1 of carcinoma and (0.4±0.1) mL·min^-1·mL^-1 of hepatic metastasis (P<0.05), the TLP was (1.4±0.4) mL·min^-1·mL^-1, greater than (0.7±0.3) mL·min^-1·mL^-1 of carcinoma and (0.8±0.4) mL·min^-1·mL^-1 of hepatic metastases, while the HAPI of hepatocellular carcinoma is (0.7±0.2) mL·min^-1·mL^-1, significantly higher than (0.4±0.1) mL·min^-1·mL^-1 of hepatic metastases and (0.5±0.2) mL·min^-1·mL^-1 of hepatic hemangioma (P<0.05); the hepatocellular carcinoma showed ring-shaped hyperechoic enhancement, and hypoechoic in delayed phase, and the contrast mode was “fast-forward and fast-out”, liver metastasis showed were uniformly enhanced, diffusely enhanced in the portal phase, and mostly hypoechoic in the delayed phase, and the hepatic hemangioma was mostly enhanced in the circumferential ring, isechoic in the delayed phase, and the contrast mode was “slow-in and slow-return”; the onset of enhancement in hepatocellular carcinoma was (13.2±4.0) s, much faster than (15.6±2.4) s and (18.7±3.2) s in liver metastases and hepatic hemangioma (P<0.05), the peak time was (19.2±3.4) s, much faster than (28.3±5.9) s and (67.3±24.2) s, while the fading time in hepatic hemangioma was (307.4±75.6)s, significantly slower than (39.1±4.2) s and (35.4±6.8)s in hepatocellular carcinoma and hepatic metastases (P<0.05). Conclusion The application of CT perfusion imaging combined with color Doppler sonography might help distinguish hepatic malignancy from benign ones.

Key words: Liver nodular lesions, Hepatocellular carcinoma, CT perfusion imaging, Contrast-enhanced ultrasound, Diagnosis

高莉, 高屹, 尹秋萍. CT灌注成像联合彩色多普勒超声造影辨别肝脏结节性病变性质临床价值探讨^*[J]. 实用肝脏病杂志, 2020, 23(1): 106-109.

Gao Li, Gao Yi, Yin Qiuping. Clinical value of CT perfusion imaging combined with color Doppler sonography in the diagnosis of hepatic nodular lesions[J]. Journal of Practical Hepatology, 2020, 23(1): 106-109.

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CT灌注成像联合彩色多普勒超声造影辨别肝脏结节性病变性质临床价值探讨^*

Clinical value of CT perfusion imaging combined with color Doppler sonography in the diagnosis of hepatic nodular lesions

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