中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (9): 709-714.doi: 10.19401/j.cnki.1007-3639.2019.09.005

• 论著 • 上一篇    下一篇

超声造影灌注时相分析在监控肝硬化结节演变和恶变中的临床价值

虞 梅 1 ,梅 琪 1 ,韩莹莹 1 ,翟凌云 1 ,沙红芳 1 ,徐祥勇 1 ,倪 娟 1 ,崔建巍 1 ,丁 红 2   

  1. 1. 上海市徐汇区大华医院超声影像科,上海 200237 ;
    2. 复旦大学附属中山医院超声科,上海 200032
  • 出版日期:2019-09-30 发布日期:2019-11-20
  • 通信作者: 丁 红 E-mail: 13651886013@163.com
  • 基金资助:
    上海市徐汇区医学科技项目(SHXH201610);国家自然科学基金项目(81571675)。

Value of contrast-enhanced ultrasound in monitoring liver cirrhotic and dysplastic nodules and early diagnosis of hepatocellular carcinomas

YU Mei 1 , MEI Qi 1 , HAN Yingying 1 , ZHAI Lingyun 1 , SHA Hongfang 1 , XU Xiangyong 1 , NI Juan 1 , CUI Jianwei 1 , DING Hong 2   

  1. 1. Department of Ultrasound, Shanghai Xuhui Dahua Hospital, Shanghai 200237, China; 2. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Published:2019-09-30 Online:2019-11-20
  • Contact: DING Hong E-mail: 13651886013@163.com

摘要: 背景与目的:原发性肝癌多在慢性肝炎、肝硬化的基础上发生,一般认为,肝硬化结节(cirrhotic nodule,CN)、异型增生结节(dysplastic nodule,DN)等一系列过程,最终演变为肝细胞癌(hepatocellular carcinoma,HCC)。应用实时超声造影对肝硬化患者进行定期跟踪监测,探讨超声造影在CN演变和HCC早期诊断中的价值。方法:在2007年3月—2017年12月于复旦大学附属中山医院就诊的9 550例慢性乙肝患者中,选取定期超声随访的392例患者的551枚结节作为研究对象,以病理学检查及影像学诊断为标准,分析不同性质结节在超声造影灌注时相的增强表现特点。结果:肝内551枚结节中确诊微小HCC(≤2 cm)55枚、DN 19枚和CN 477枚。常规超声显示,肝内CN、DN和HCC均以低回声多见,分别占61.6%(294/477)、78.9%(15/19)和67.3%(37/55)。超声造影显示,CN的造影特征以等-等-等的增强方式为主,占89.5%(427/477);DN的造影特征以低-等-等的增强方式最多见,占52.6%(10/19);微小HCC的造影特征则以高-等-等和高-等-低的增强方式最多见,占85.5%(47/55)。超声造影诊断CN、DN和HCC的准确率分别为93.3%、78.9%和85.5%。结论:超声造影灌注时相分析可客观地反映肝内CN、DN及微小HCC的不同灌注模式,应用超声造影定期监测肝硬化的结节,可及时预警和早期诊断微小HCC,改善患者预后。

Abstract: Background and purpose: Primary liver cancer occurs mostly on the basis of chronic hepatitis and liver cirrhosis. It generally develops through a series of processes, such as cirrhotic nodule (CN) and dysplastic nodules (DN), and finally evolves into hepatocellular carcinoma (HCC). In this study, contrast-enhanced ultrasound (CEUS) was used to monitor patients with cirrhotic nodules regularly, and the value of CEUS was evaluated in the early diagnosis of HCC. Methods: From January 2007 to December 2017, 9 550 patients with chronic liver cirrhosis who treated in Zhongshan Hospital, Fudan University were enrolled, among them 392 patients with 551 intrahepatic nodules were examined every 3 to 6 months. The perfusion features on CEUS were analyzed and compared with the results of pathological and imaging diagnosis. Results: Among 551 intrahepatic nodules, there were 55 small HCCs (less than 2 cm), 19 DNs and 477 CNs confirmed clinically. Conventional ultrasound showed hypoechogenic nodules in 61.6% (294/477) of CNs, 78.9% (15/19) of DNs and 67.3% (37/55) of HCCs. On CEUS, the most common perfusion features of nodules in three vascular phases were iso-iso-iso enhancement pattern in CN (89.5%, 427/477), hypo-iso-iso pattern in DN (52.6%, 10/19) and hyper-iso-iso enhancement and hyper-iso-hypo enhancement patterns in small HCC (85.5%, 47/55) compared with liver parenchyma. The diagnostic accuracy of CEUS was 93.3%, 78.9% and 85.5% for CN, DN and HCC, respectively. Conclusion: CEUS reflects the perfusion features of CN, DN and HCC objectively. Regular monitoring of cirrhotic nodules with CEUS makes prompt warning and early diagnosis of small HCC possible in clinical setting.