肝转移癌超声造影增强模式表现分析

doi:10.3969/j.issn.1672-5069.2020.03.032

摘要/Abstract

摘要： 目的研究肝转移癌患者肝内病灶超声造影(CEUS)增强模式。方法 2016年1月～2019年1月我院诊治的肝转移癌患者76例,经手术或病灶活检病理学检查诊断,行CEUS和CT增强扫描检查,根据病灶在CT扫描肝动脉期表现为低密度灶者称为乏血供病灶,表现为高密度或等密度灶者为富血供病灶。结果本组肝转移癌的原发灶包括结肠癌50例(65.8%)、乳腺癌7例(9.2%)、肺癌5例(6.6%)、胃癌5例(6.6%)、胰腺癌4例(5.3%)、胰腺神经内分泌肿瘤3例(3.9%)、卵巢癌2例(2.6%);乏血供组肝转移癌来自结肠癌、肺癌、胃癌、胰腺癌和卵巢癌,富血供组肝转移癌来自胰腺神经内分泌肿瘤和乳腺癌;CEUS动脉期成像表现为高增强、局部高增强、同步等增强和不均匀低增强。乏血供组108个病灶动脉期呈高增强、局部高增强、同步等增强和不均匀低增强发生率分别为52.8%、35.2%、3.7%和8.3%,与富血供组24个病灶的87.5%、12.5%、0.0%和0.0%比,差异显著(P<0.05);乏血供组病灶门脉期呈低增强和等增强发生率为分别为99.1%和0.9%,延迟期呈低增强和等增强发生率分别为99.1%和0.9%,与富血供组比,差异显著(分别为70.8%、29.2%、79.2%和20.8%,P<0.05);乏血供组病灶增强时间和病灶达峰时间分别为(17.6±3.8)s和(23.0±4.8)s,显著长于富血供组【分别为(15.2±2.9)s和(19.8±5.9)s,P<0.05],而病灶增强廓清时间为(41.1±23.4)s,显著短于富血供组。结论肝转移癌以乏血供病灶为主,常见的CEUS动脉期增强模式为短暂均匀强化后快速廓清,找到原发病灶有助于对肝内病灶的定性。

关键词: 肝转移癌, 超声造影, 增强模式, 高增强, 达峰时间, 诊断 , ,

Abstract: Objective The purpose of this study was to summarize the enhancement pattern of liver metastases (LM) in contrast-enhanced ultrasonography (CEUS). Methods A total of 76 patients with LM were encountered in our hospital between January 2016 and January 2019, and all of them underwent CEUS and CT scan. The diagnosis of LM was proven by post-operational or liver biopsy with typical pre-operational MRI and / or CT scan. According to the enhancement feature of the lesions in hepatic arterial phase of CT scan, the lesions were divided into poor blood supply (hypovascular, low density in hepatic arterial phase) and rich blood supply (hypervascular, high or equal density). Results The primary foci of liver metastases in our series included colon cancer in 65.8%, breast cancer in 9.2%, lung cancer in 6.6%, gastric cancer in 6.6%), pancreatic cancer in 5.3%, pancreatic neuroendocrine tumors in 3.9% and ovarian cancer in 2.6%; the hypovascular group of LM arisen from colon cancer, lung cancer, gastric cancer, pancreatic cancer and ovarian cancer, and the hypervascular group were from neuroendocrine tumors and breast cancer; the CEUS arterial phase imaging showed homogeneous hyperenhancement, rim-like hyperenhancement, heterogeneous hyperenhancement and isoenhancement; at arterial phase, the incidences of focal homogeneous hyperenhancement, rim-like hyperenhancement, isoenhancement and heterogeneous hyperenhancement in 108 foci in hypovascular group were 52.8%, 35.2%, 3.7% and 8.3%, significantly different as compared to 87.5%, 12.5%, 0.0% and 0.0%, respectively (P<0.05) in 24 hypervascular foci; at portal phase, the incidences of hypoenhancement and isoenhancement in foci with poor blood supply were 99.1% and 0.9%, and at delayed phase, the incidences of hypoenhancement and isoenhancement were 99.1% and 0.9%, significantly different as compared to 70.8%, 29.2%, 79.2% and 20.8%, respectively (P<0.05) in rich blood supply; the initial time of enhancement and the enhancement time to peak in hypovascular group were (17.6±3.8)s and (23.0±4.8)s, much longer than in hypervascular group, while the washout time was(41.1±23.4)s, significantly shorter than in hypervascular group. Conclusion The common LM is poor blood supply foci, with homogeneous CEUS hyperenhancement and quick clearance, and the demonstration of primary foci is helpful for the diagnosis of LM in clinical practice.

Key words: Liver metastases, Contrast-enhanced ultrasonography, Enhancement pattern, Enhancement time to peak, Diagnosis

曹东明,景香香,林运旺. 肝转移癌超声造影增强模式表现分析[J]. 实用肝脏病杂志, 2020, 23(3): 431-434.

Cao Dongming,Jing Xiangxiang,Lin Yunwang. Enhancement pattern of liver metastasis in contrast-enhanced ultrasonography: An analysis of 76 cases[J]. Journal of Practical Hepatology, 2020, 23(3): 431-434.

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