肝脏局灶性病变的三维超声造影研究

发布时间：2018-06-02 02:16

本文选题：FLL + 3D-CEUS　；参考：《福建医科大学》2014年硕士论文

【摘要】：目的：探讨肝脏局灶性病变（FLL）的三维超声造影（3D-CEUS）声像特征及其临床应用价值。方法：使用PHILIPS IU22超声诊断仪、C5-1凸阵探头、V6-2三维容积探头以及声诺维超声造影剂，经肘静脉团注法对127例二维超声造影（2D-CEUS）检查动脉相早期有增强的FLL进行3D-CEUS检查。2D-CEUS检查观察各局灶性病变的动脉相增强方式及增强模式，3D-CEUS检查经处理后观察病灶动脉相增强方式、病灶内部结构，以及滋养血管数目、分布及形态等，分析两种检查方法的观察参数对病灶性质的诊断价值。以P＜0.05为差异有统计学意义。结果： 1、FLL3D-CEUS典型声像表现：本文75例肝细胞性肝癌(HCC)中有74例（98.7%）3D-CEUS表现为动脉相均匀/不均性整体增强（实心球样改变）,病灶滋养血管数目随体积增大而增加，大于1cm HCC供养血供呈多源性向病灶内部延伸的紊乱滋养血管；31例肝血管瘤（HCH）均（100%）表现为动脉相环状增强或向心性增强（空心球样改变）伴周边一侧结节样聚集规则滋养血管；11例肝局灶性结节性增生（FNH）有10例（90.9%）表现为动脉相早期病灶边缘一支滋养血管进入病灶内部达中心呈放射状分支离心性增强；7例肝脓肿表现为病灶内部不均匀整体增强及该区域正常血管向病灶内部延伸，血管形态规整；2例肝血管周上皮细胞样肿瘤（PEC）表现为动脉相整体增强，病灶周边多源性紊乱滋养血管，但未见向病灶内部延伸；1例肝淋巴瘤（PHL）动脉相整体增强及周边粗大滋养血管交错并平直延伸至病灶内部。 2、FLL2D-CEUS不典型病例的3D-CEUS声像表现：本文HCC、HCH及FNH共117例，其中16例（16/117）2D-CEUS声像表现不典型，这16例中有15例（93.8%）具有典型3D-CEUS声像表现。（1）本组75例HCC有8例（10.7%）2D-CEUS表现不典型，其中3例动脉相增强方式呈环状增强，3D-CEUS仍可见周边多源性向病灶内部延伸的紊乱滋养血管；5例增强模式为不出，3D-CEUS均呈现出典型HCC声像改变。（2）本组31例HCH有5例（16.1%）2D-CEUS表现不典型，其中4例为动脉相整体增强，另1例为动脉相环状增强伴快出，这5例HCH3D-CEUS均呈现出典型HCH声像改变。（3）本组11例FNH有3例（27.3%）2D-CEUS动脉相整体增强，未见离心性增强过程，其中有2例3D-CEUS可见动脉相早期可见典型FNH3D-CEUS特征。 3、3D-CEUS对HCC病灶的滋养血管检出率（100%）显著高于2D-CEUS（74.7%，56/75）。HCC病灶大小与滋养血管检出数呈正相关（P＜0.05，r=0.625）；而病灶分化程度与滋养血管数目间无明显相关（P＞0.05）。结论：本组FLL各有其独特的3D-CEUS声像特征，主要表现在动脉相增强方式及滋养血管分布及形态方面的差异。3D-CEUS病灶滋养血管的检出率及显示质量优于2D-CEUS。肝脏3D-CEUS提高了对2D-CEUS不典型病例的超声鉴别诊断能力。在2D-CEUS基础上行肝脏3D-CEUS检查，，对提高FLL的定性诊断具有重要的临床应用价值。
[Abstract]:Objective: to investigate the sonographic features of three dimensional contrast-enhanced ultrasonography (3D CEUS3 D) and its clinical value in focal hepatic lesions (FLLL). Methods: V6-2 three-dimensional volume probe and sonovir ultrasound contrast medium were used in PHILIPS IU22 ultrasonic diagnostic instrument. Two-dimensional contrast-enhanced FLL (2D-CEUS) was performed in 127 patients with early arterial phase enhancement by cubital venous mass injection. The arterial phase enhancement mode of each focal lesion was observed by 3D-CEUS, and the arterial phase enhancement mode was observed by contrast-enhanced 3D-CEUS. The internal structure of the lesion, the number, distribution and morphology of the trophoblastic vessels were analyzed. The diagnostic value of the observation parameters of the two methods in the diagnosis of the lesions was analyzed. The difference was statistically significant (P < 0.05). Results: 1FLTL3D-CEUS: 74 out of 75 cases of hepatocellular carcinoma (HCC) showed homogeneous / uneven enhancement of the arterial phase (solid globular changes), and the number of trophoblastic vessels increased with the increase of volume. In 31 patients with hepatic hemangioma, 31 patients with hepatic hemangioma were presented with annular enhancement or concentric enhancement (hollow ball like change) with peripheral nodular aggregation. Of the 11 cases of hepatic focal nodular hyperplasia (FNH), 10 cases presented as follows: early arterial phase, the edge of the lesion, a trophoblastic vessel entering the center of the lesion, centrifugal enhancement of radial branches, and 7 cases of liver abscess presented as intra focus. The normal blood vessels in the region extended to the inner part of the lesion. In 2 cases of hepatic perivascular epithelioid tumor (PECs), the arterial phase was enhanced as a whole, and the peripheral blood vessels were nourished by multi-source disorder. However, no extension to the lesion was seen in 1 case of hepatic lymphoma. The whole enhancement of PHL artery and the interlacing of the peripheral coarse nourishing vessels extended to the lesion. 2FLTL2D-CEUS: there were 117 cases of HCH and FNH in this study, of which 16 cases were atypical in 16 / 117D CEUs, 15 of them had typical 3D-CEUS sonographic manifestations.) of the 75 cases of HCC, 8 cases were 10.7D-CEUS. 3D-CEUS was still seen in 3 cases of arterial phase enhancement. 5 cases showed typical changes of HCC image. 5 cases of 31 cases of HCH showed atypical findings of 16.1% and 2D-CEUS. Among them, 4 cases were arterial phase enhancement, the other 1 case was arterial phase annular enhancement with rapid exit. All the 5 cases of HCH3D-CEUS showed typical changes of HCH image.) in 11 cases of FNH, 3 cases of FNH showed the whole enhancement of arterial phase of 27.3D CEUS, but no process of eccentric enhancement. Typical FNH3D-CEUS features were found in 2 cases of 3D-CEUS at the early stage of arterial phase. The positive correlation between the size of the lesions and the number of trophoblastic vessels was significant (P < 0.05), but there was no significant correlation between the degree of lesion differentiation and the number of trophoblastic vessels (P > 0.05). Conclusion: Each of the FLL had its unique characteristics of 3D-CEUS sonography, mainly manifested in the difference of arterial phase enhancement mode and the distribution and morphology of the trophoblastic vessels. 3The detection rate and the display quality of the lesion nourishing vessels were better than 2D-CEUSs. Liver 3D-CEUS improves the ability of ultrasonic differential diagnosis in atypical cases of 2D-CEUS. Liver 3D-CEUS examination on the basis of 2D-CEUS has important clinical application value in improving the qualitative diagnosis of FLL.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1

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