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目的:对比分析肝硬化合并小结节样病灶(≤3cm)的常规超声和超声造影(CEUS)显像特征。方法:应用造影剂SonoVue及对比脉冲序列技术(CPS)对常规超声检出的69灶肝硬化合并的小结节样病灶进行CEUS观察,所有病灶均行穿刺活检或手术切除病理证实。结果:分析本组69个病灶随不同造影时相增强的特点,发现从大再生结节(LRN)、低度增生不良结节(DN)、高度DN、高分化肝细胞癌(SHCC)至中低分化SHCC组开始增强时间和完全消退时间均呈递减趋势;并由本组归纳总结6种CEUS增强模式,各组结节增强模式构成分别不同,92.3%的LRN为模式Ⅰ～Ⅱ型,58.3%的LGDN为模式Ⅲ型,83.8%的HGDN主要为模式Ⅳ型,83.3%的SHCC为模式Ⅴ和Ⅵ型,其中高分化SHCC主要为模式Ⅴ型,低分化SHCC具有特征性模式Ⅵ型,1例癌变DN表现为混合型模式(Ⅲ+Ⅴ)型。CEUS判断不同病灶良恶性优于常规超声(P<0.01);CEUS和增强CT对本组病灶不同时相增强结果一致。结论:CEUS提高了超声显像对肝硬化癌变过程中小结节病灶的定性诊断价值。
OBJECTIVE: To compare and analyze the features of conventional ultrasound and contrast-enhanced ultrasonography (CEUS) imaging of cirrhosis with small nodular lesions (≤3cm). Methods: CEUS was performed on 69 patients with cirrhosis complicated with small nodules detected by SonoVue and contrast pulse sequence (CPS). All lesions were confirmed by biopsy or surgical resection. Results: The characteristics of 69 lesions in this group with different contrast phases were analyzed. It was found that there were significant differences between the two groups (LRN, DN, DN, HCC) In the poorly differentiated SHCC group, the onset time and the complete subsidence time showed a decreasing trend. Six CEUS enhancement modes were summarized in this study. The enhancement modes of nodules were different in each group. 92.3% of LRNs were in type Ⅰ-Ⅱ and 58.3 % Of LGDN were in type Ⅲ, 83.8% of HGDN were in type Ⅳ, 83.3% of SHCC were in type Ⅴ and Ⅵ, of which highly differentiated SHCC were mainly in type Ⅴ, while poorly differentiated SHCC had characteristic in type Ⅵ, 1 Cases of DN showed mixed mode (Ⅲ + Ⅴ) type. CEUS to determine the different benign and malignant lesions better than conventional ultrasound (P <0.01); CEUS and enhanced CT in this group lesions enhanced at different phases consistent results. CONCLUSIONS: CEUS improves the qualitative diagnostic value of ultrasonography in the diagnosis of small nodules in carcinogenesis of cirrhosis.