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超声造影在≤3 cm肝细胞癌及肝局灶性结节增生鉴别诊断中的应用

Application of contrast-enhanced ultrasound in differential diagnosis of ≤ 3 cm hepatocellular carcinoma and focal nodular hyperplasia of the liver

    摘要
  • 摘要:
    目的 探讨超声造影（contrast-enhanced ultrasound, CEUS）在最大径≤3cm的肝细胞癌（hepatocellular carcinoma，HCC）与肝局灶性结节增生（focal nodular hyperplasia, FNH）鉴别诊断中的价值。
    方法 回顾性分析经病理检查证实的48例肿瘤最大径≤3 cm的HCC及48例肿瘤最大径≤3 cm的FNH患者的CEUS图像。对比两组病灶的CEUS时相变化、增强模式及增强特征。
    结果 两组病灶均在动脉期高回声增强，HCC组与FNH组分别在17(15, 19) s、15(12,18.75) s开始增强（P＝0.017）；两组增强达峰时间差异无统计学意义22(19, 26) s vs 21(17, 25) s。HCC组及FNH组在动脉期的主要增强方式分别是整体增强、离心性增强。HCC组表现为整体增强的病灶占比明显高于FNH组（100% vs 2.08%，P＜0.05）；FNH组表现为离心性增强的病灶占比高于HCC组（97.91% vs 0，P＜0.05）。在整个CEUS过程中，HCC组表现为“快进快出”的病灶占比高于FNH组（87.50% vs 8.33%，P＜0.05），FNH表现为“快进同出”/“快进慢出”的病灶占比高于HCC组 （91.67% vs 12.50%，P＜0.05）。
    结论 CEUS能鉴别≤3 cm的HCC和FNH。

     

    Abstract:
    Objective To investigate the diagnosis value of contrast-enhanced ultrasound (CEUS) in the differentiation of hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) of the liver with ≤3 cm of maximum diameter.
    Methods The image characteristics in 48 lesions of HCC with maximum diameter≤3 cm and 48 lesions of FNH with maximum diameter≤3 cm confirmed by pathology were retrospectively analyzed. The phase changes, enhancement patterns and enhancement characteristics of the lesions in the two groups were compared.
    Results All lesions in the two groups showed high-echo in the arterial phase. The contrast arrival time in HCC group and FNH group was 17(15, 19) s and 15(12, 18.75) s (P＝0.017); the peak time in the two groups was 21(17, 25) s and 22(19, 26) s (P＞0.05). The main enhancement patterns of HCC group and FNH group in arterial phase were homogeneous enhancement and centrifugal enhancement, respectively. All HCC lesions showed homogeneous enhancement, which was significantly higher than FNH (2.08%, P＜0.05); 97.91% of FHN lesions showed centrifugal enhancement, which was higher that of HCC lesions (0, P＜0.05). During the CEUS process, 87.5% of HCC lesions showed “rapid fill-in and rapid wash-out”, which was significantly higher than that of FNH lesions（8.33%, P＜0.05）; 91.67% of FNH lesions showed “rapid fill-in” and “synchronous/slow wash-out” which was significantly higher than that of HCC lesions （12.50%, P＜0.05）.
    Conclusion CEUS is helpful in the differential diagnosis of FNH and HCC with maximum diameter≤3 cm．

     

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