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小于3 cm肝细胞腺瘤和肝局灶性结节增生超声造影特征对比

Comparison of contrast-enhanced ultrasound features between hepatocellular adenoma and focal nodular hyperplasia smaller than 3 cm

    摘要
  • 摘要:
    目的 对比分析最大径＜3 cm的肝细胞腺瘤（HCA）和肝局灶性结节增生（FNH）的超声造影（CEUS）特征，探讨CEUS对两者的鉴别诊断价值。
    方法 收集经手术后穿刺病理证实的25个最大径＜3 cm的HCA和48个最大径＜3 cm的FNH病灶，经外周静脉团注造影剂SonoVue后，观察两者动脉期增强方式、门脉期及延迟期增强强度、滋养动脉、中央瘢痕、包膜下增强血管影等表现。
    结果 最大径＜3 cm的HCA和FNH病灶在动脉期均表现为快速增强，其中，HCA以整体增强（21个，84.0%）为主，FNH以泉涌状增强（41个，85.4%）为主（P＜0.001）。门脉期，HCA减退呈低回声增强（10个，40%），FNH表现为高回声增强（10个，20.8%）或等回声增强（38个，79.2%；P＜0.001）；延迟期，分别有13个（52.0%）HCA和2个（4.2%）FNH减退呈低回声增强（P=0.003）。HCA滋养动脉检出率低于FNH（12.0% vs 52.1%，P=0.001）；HCA包膜下增强血管影检出率显著高于FNH（56.0% vs 10.4%，P＜0.001）。CEUS动脉期整体高回声增强或包膜下增强血管影诊断HCA的灵敏度、特异度、准确度分别为88.0%、87.5%、87.7%；CEUS动脉期泉涌状增强、中央瘢痕、延迟期等回声或高回声增强为标准诊断FNH的灵敏度、特异度、准确度分别为93.8%、84.0%、93.2%。
    结论 对于最大径小于3 cm的肝脏病灶，CEUS表现为动脉期整体高回声增强或包膜下增强血管影提示HCA，动脉期泉涌状增强或中央瘢痕或延迟期等回声或高回声增强提示FNH。

     

    Abstract:
    Objective To compare the contrast-enhanced ultrasound (CEUS) features of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) smaller than 3 cm.
    Methods 25 HCA lesions and 48 FNH lesions with maximum diameter smaller than 3 cm confirmed by histopathological examination after surgery were enrolled in this study. After intravenous bolus injection of SonoVue, the CEUS features such as enhancement pattern in the arterial phase, enhancement intensity in portal venous and late phase, feeding artery, central scar and subcapsular vascular enhancement were analyzed.
    Results All HCA and FNH lesions showed rapid enhancement in arterial phase. 21(84.0%) HCAs presented overall enhancement, while 41(85.4%) FNHs presented gushing-spring enhancement (P < 0.001). In portal venous phase, 10(40%) HCAs showed hypoenhancement, FNHs continued hyperenhancement (10, 20.8%) or isoenhancement (38, 79.2%; P < 0.001). During late phase, 13 (52.0%) HCAs and 2(4.2%) FNHs showed hypoenhancement (P=0.003). The detection rate of feeding artery in HCAs was significantly lower than that in FNHs (12.0% vs 52.1%, P=0.001), whereas the detection rate of subcapsular vascular enhancement in HCAs was significantly higher than that in FNHs (56.0% vs 10.4%, P < 0.001). The sensitivity, specificity and accuracy of "overall hyperenhancement in the arterial phase" or "subcapsular vascular enhancement" in CEUS for HCA were 88.0%, 87.5% and 87.7%, respectively; those of "gushing-spring hyperenhancement in the arterial phase", or "central scar", or "continuous hyper- or iso-enhancement in late phase" in CEUS for FNH were 93.8%, 84.0% and 93.2% respectively.
    Conclusions For liver lesion smaller than 3 cm, overall hyperenhancement in the arterial phase and subcapsular vascular enhancement in CEUS indicate HCA, while gushing-spring hyperenhancement in the arterial phase, central scar, and continuous hyper- or iso-enhancement in late phase in CEUS indicate FNH.

     

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