肝脓肿患者超声造影特点及诊断价值分析

doi:10.3969/j.issn.1672-5069.2020.03.033

摘要/Abstract

摘要： 目的研究肝脓肿患者超声造影(CEUS)检查表现特点及诊断价值。方法 2016年4月～2019年4月我院收治的120例肝脓肿患者,行常规二维超声和CEUS检查,分析其影像学特征,以穿刺治疗结果为金标准,分析CEUS和常规二维超声诊断肝脓肿病灶的一致性。结果在120例患者中,脓肿炎性期22例,脓肿形成初期42例和脓肿形成期56例;常规二维超声检出107例(89.2%),其中脓肿炎性期和脓肿形成初期影像学表现为不规则或规则病灶,病灶边界不清晰或清晰,病灶内未见液性暗区,可见血流信号,脓肿形成期影像学表现为不规则或规则病灶,病灶边界不清晰或清晰,病灶内见液性暗区,无血流信号;CEUS检出肝脓肿117例(95.0%),其中脓肿炎性期和脓肿形成初期影像学表现为病灶动脉期高增强,门静脉期和延迟期低增强,显示范围较常规超声明显增大,脓肿形成期影像学表现为病灶动脉期高增强,门静脉期和延迟期低增强现象减少,显示范围较常规超声明显增大;CEUS诊断肝脓肿病灶的灵敏度为95.0%,特异度为76.9%,阳性预测值为89.7%,阴性预测值为33.3%,Kappa值为0.88。结论不同病程的肝脓肿CEUS影像学表现各有特点,其诊断肝脓肿的灵敏度、特异度和准确性均较高,在鉴别诊断有困难时可以考虑应用。

关键词: 肝脓肿, 超声造影, 二维超声, 诊断 , ,

Abstract: Objective The aim of this study was to summarize the contrast-enhanced ultrasonography (CEUS) imaging manifestation of liver abscess (LA). Methods 120 patients with LA were admitted to our hospital from April 2016 through April 2019, and all patients underwent routine two-dimensional ultrasonography and CEUS before abscess puncture drainage. The consistency of CEUS and routine two-dimensional ultrasound in diagnosis of LA was compared. Results Out of the120 patients, 22 cases were at inflammatory stage of abscess, 42 cases wereat early abscess formation and 56 cases were at abscess formation; 107 cases (89.2%) were detected by routine two-dimensional ultrasonography, and among them, the abscesses at inflammatory and at early stage of abscess formation showed irregular or regular lesions with unclear or clear boundary, without liquid dark area in the lesions and having blood flow signals, and those at abscess formation demonstrated the irregular or regular lesions with unclear orclear borders and fluid dark areas without blood flow signals; 117 LA cases (95.0%) were detected by CEUS, and among them, the abscesses at inflammatory stage of abscess and at early stage of abscess formation presented high enhancement at the arterial phase, low enhancement at portal venous and delayed phase with the display range larger than that by conventional ultrasound, and those at abscess formation manifested high enhancement at arterial phase, low enhancement at portal vein and delayed phase, and their display range significantly larger than that by conventional ultrasound; the sensitivity, specificity, positive predictive value, negative predictive value and Kappa value by CEUS were 95.0%, 76.9%, 89.7%, 33.3% and 0.88, respectively. Conclusion The LA CEUS imaging manifestations have their own characteristics, and the sensitivity, specificity and accuracy of diagnosis by it are high, and we recommend its application when the diagnosis is obscure.

Key words: Liver abscess, Contrast-enhanced ultrasonography, Two-dimensional ultrasonography, Diagnosis

兰方荣,洪可. 肝脓肿患者超声造影特点及诊断价值分析[J]. 实用肝脏病杂志, 2020, 23(3): 435-438.

Lan Fangrong, Hong Ke. CEUS imaging manifestation of liver abscess: An analysis of 120 patients[J]. Journal of Practical Hepatology, 2020, 23(3): 435-438.

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