肝血管瘤、肝细胞癌和肝血管平滑肌脂肪瘤超声造影特点观察*

doi:10.3969/j.issn.1672-5069.2021.06.036

摘要/Abstract

摘要： 目的探讨肝血管瘤(HCH)、肝细胞癌(HCC)和肝血管平滑肌脂肪瘤(HAML)患者肝内病灶超声造影特点。方法 2017年11月～2020年11月我院诊治的肝占位病变患者112例,所有患者入院后均在治疗前接受常规超声和超声造影检查,观察肝内病灶数目、大小、边界、回声、形态、血供等信息,同时观察超声造影检查过程中动脉期、门静脉期和延迟期病灶的增强模式。结果经组织病理学检查诊断为HCH患者39例,HCC患者64例和HMAL患者9例;HCH患者女性占比为66.7%,显著高于HCC或HAML患者(分别为18.8%和33.3%,P＜0.05),HCC患者年龄为(57.5±5.8)岁,HMAL患者年龄为(55.3±5.1)岁,均显著大于HCH患者【(46.2±5.2)岁,P<0.05】,HCC患者存在HBV感染发生率为76.6%,显著高于HMAL患者的28.6%或HCH患者的12.8%(P<0.05);在普通超声检查,HCC病灶边界不清、实质呈低回声和混合回声占比分别为65.6%、43.8%和42.2%,显著高于HCH病灶的2.6%、10.3%和7.7%或HAML病灶的0.0%、11.1%和11.1%(P＜0.05),HCH、HCC和HAML患者肝内病灶数目、病灶大小、形态和血供比较,差异无统计学意义(P＞0.05);在超声造影检查方面,HCH病灶在动脉期呈高增强占比为92.3%,显著高于HCC病灶的87.5%或HMAL病灶的88.9%(P＜0.05),HCC病灶门静脉期和延迟期呈低增强占比分别为65.6%和90.6%,显著高于HCH病灶的5.1%和43.6%或HMAL病灶的11.1%和22.2%(P＜0.05)。结论 HAML、HCH和HCC病灶在超声检查方面各具特点,而超声造影检查更具诊断和鉴别诊断价值,值得进一步研究。

关键词: 肝细胞癌, 肝血管瘤, 肝血管平滑肌脂肪瘤, 超声检查, 超声造影, 诊断

Abstract: Objective The aim of this study was to summarize the contrast-enhanced ultrasound (CEUS) features of hepatic hemangioma (HCH), hepatocellular carcinoma (HCC)and hepatic angiomyolipoma(HAML). Methods A total of 112 patients with intrahepatic occupying lesions were encountered in our hospital between November 2017 and November 2020, and all underwent histopathological examination. The patients received conventional sonography and CEUS check-up after admission before treatment. Two experienced ultrasound physicians read the images in a blind way to observe the number, size, boundary, echo, morphology, blood supply and other information of hepatic lesions in conventional ultrasound examination, and observe the enhancement pattern at arterial phase, portal vein phase and delayed phase in contrast-enhanced ultrasound examination. Results The histopathological examination showed HCH in 39 cases, HCC in 64 cases and HMAL in 9 cases out of our series; the female accounted for 66.7% in patients with HCH, significantly higher than 18.8% in patients with HCC or 33.3% in patients with HAML (P＜0.05), the average age of patients with HCC was (57.5±5.8)yr, and that in patients with HMAL was (55.3±5.1)yr, both significantly higher than [(46.2±5.2)岁, P<0.05] in patients with HCH, the incidence of hepatitis B viral infection in patients with HCC was 76.6%, significantly higher than 28.6% in patients with HMAL or 12.8%(P<0.05)in patients with HCH; the conventional ultrasound scan showed that the proportions of unclear boundary, low echo and mixed echo of lesions in patients with HCC were 65.6%, 43.8% and 42.2%, significantly higher than 2.6%, 10.3% and 7.7% in patients with HCH or 0.0%, 11.1% and 11.1% in patients with HAML(P＜0.05), and there were no significant differences as respect to hepatic tumor number, size, shape and blood supply among lesions in patients with HCH, HCC and HAML(P＞0.05); the CEUS demonstrated the percentage of intensified enhancement of HCH lesions at arterial phase was 92.3%, significantly higher than 87.5% in HCC lesions or 88.9% in HMALlesions (P＜0.05), the proportion of low enhancement of lesions at portal phase and delayed phase in patients with HCC were 65.6% and 90.6%, both significantly higher than 5.1% and 43.6% in patients with HCH or 11.1% and 22.2% in patients with HMAL(P＜0.05). Conclusion The conventional ultrasound and contrast-enhanced ultrasonography are helpful in diagnosing and discriminating intrahepatic occupying lesions, which warrants further clinical multi-central study.

Key words: Hepatoma, Hepatic hemangioma, Hepatic angiomyolipoma, Contrast-enhanced ultrasound, Diagnosis

周正, 刘玮. 肝血管瘤、肝细胞癌和肝血管平滑肌脂肪瘤超声造影特点观察^*[J]. 实用肝脏病杂志, 2021, 24(6): 911-914.

Zhou Zheng, Liu Wei. Contrast-enhanced ultrasound features of hepatic hemangioma, hepatocellular carcinoma and hepatic angiomyolipoma[J]. Journal of Practical Hepatology, 2021, 24(6): 911-914.

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肝血管瘤、肝细胞癌和肝血管平滑肌脂肪瘤超声造影特点观察^*

Contrast-enhanced ultrasound features of hepatic hemangioma, hepatocellular carcinoma and hepatic angiomyolipoma

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