超声造影在肝局灶性病变诊断中的应用研究

发布时间：2018-10-29 19:17

【摘要】：肝脏的局灶性病变很常见,分为恶性局灶性病变和良性局灶性病变两大类。常见的恶性局灶性病变包括肝细胞性肝癌、胆管细胞性肝癌和转移性肝癌等,良性局灶性病变包括肝血管瘤、局灶性病变样增生、肝腺瘤、肝脓肿、炎性假瘤、肝结核等。常规彩色多普勒超声由于无辐射、无创伤、方便快捷、价格低廉、适用性广等优点成为肝脏检查的首选方法。但由于肝脏局灶性病变的常规彩色多普勒超声上的表现多样,有很多相似之处,所以很难鉴别。超声造影(Contrast-enhanced Ultrasound,CEUS)能客观地反映组织微血管的血流灌注情况,大大的提高超声诊断肝脏局灶性病变的敏感性和特异性[1]。研究目的:通过研究不同类型的肝局灶性病变的超声造影表现,探讨超声造影在肝局灶性病变诊断及鉴别诊断中的应用价值。研究方法:回顾分析2014年1月至2016年1月在我院经病理证实或由增强CT或MRI并随访12个月以上证实的93例肝局灶性病变病人超声造影结果,记录病人的年龄、性别、临床检验学指标;评估病人肝脏的整体情况,有无脂肪肝或肝硬化;记录二维超声中病灶的大小、数目、位置、边界,内部回声及彩色多普勒血流情况;分析病灶的超声造影图像特征,记录动脉期、门脉期、延迟期的增强特点,记录开始增强的时间,达峰时间、消退时间。结果:93例肝局灶性病变病人共119个病灶,肝右叶71个,肝左叶48个,肝细胞性肝癌25例28个病灶,胆管细胞性肝癌1例1个病灶,转移性肝癌11例18个病灶,肝血管瘤19例26个病灶,肝局灶性病变样增生16例20个病灶,肝腺瘤6例8个病灶,肝脓肿12例14个病灶,肝结核3例4个病灶。这些病灶造影后的增强方式随时间变化而动态改变。大部分病灶在动脉期、门脉期及延迟期有其特异性的表现。结论:超声造影能客观地反映组织微血管的血流灌注情况,对肝脏局灶性病变鉴别诊断有重要价值;肝脏超声造影能弥补常规超声的不足,检出常规超声未发现的病灶,提高肝局灶性病变的诊断准确性。
[Abstract]:Focal liver lesions are common and can be classified into malignant focal lesions and benign focal lesions. Common malignant focal lesions include hepatocellular carcinoma, cholangiocarcinoma and metastatic liver cancer. Benign focal lesions include hepatic hemangioma, focal lesion like hyperplasia, hepatic adenoma, liver abscess, inflammatory pseudotumor, hepatic tuberculosis and so on. Conventional color Doppler ultrasound has become the preferred method for liver examination because of its advantages of no radiation, no injury, convenience, low price and wide applicability. However, it is difficult to differentiate focal liver lesions due to the variety of conventional color Doppler ultrasound findings and many similarities. Contrast-enhanced ultrasound (Contrast-enhanced Ultrasound,CEUS) can objectively reflect the blood flow perfusion of tissue microvessels, and greatly improve the sensitivity and specificity of ultrasound in the diagnosis of focal liver lesions [1]. Objective: to investigate the value of contrast-enhanced ultrasonography in the diagnosis and differential diagnosis of focal hepatic lesions. Methods: from January 2014 to January 2016, 93 patients with focal hepatic lesions confirmed pathologically or by enhanced CT or MRI and followed up for more than 12 months were retrospectively analyzed. The age and sex of the patients were recorded. Clinical laboratory indexes; The size, number, location, boundary, internal echo and color Doppler flow of the lesions in two-dimensional ultrasound were recorded. The contrast-enhanced features of the lesions were analyzed, and the enhancement characteristics of arterial phase, portal phase and delayed phase were recorded, and the time of beginning enhancement, peak time and extinction time were recorded. Results: there were 119 lesions in 93 patients with focal hepatic lesions, including 71 lesions in the right lobe of liver, 48 lesions in Zuo Ye, 28 lesions in 25 cases of hepatocellular carcinoma, 1 case in 1 case of cholangiocarcinoma and 18 lesions in 11 cases of metastatic liver cancer. There were 26 lesions in 19 cases of hepatic hemangioma, 20 lesions in 16 cases of hepatic focal lesion like hyperplasia, 8 lesions in 6 cases of hepatic adenoma, 14 lesions in 12 cases of liver abscess and 4 lesions in 3 cases of hepatic tuberculosis. The enhancement patterns of these lesions changed dynamically over time. Most of the lesions have specific manifestations in arterial phase, portal phase and delayed phase. Conclusion: contrast-enhanced ultrasound can objectively reflect the blood flow perfusion of tissue microvessels and has important value in differential diagnosis of focal liver lesions. Liver contrast-enhanced ultrasound can make up for the deficiency of conventional ultrasound, detect the undetected lesions of conventional ultrasound, and improve the diagnostic accuracy of focal hepatic lesions.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R575

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