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目的探讨超声造影在诊断肝脏高回声病灶中的应用价值。方法回顾性分析行常规超声检查可疑肝癌的78例患者90个肝脏高回声病灶资料,分析其超声造影特征,结合血清甲胎蛋白初诊,最后行超声引导下穿刺活检病理确诊。结果 90个病灶超声造影诊断恶性病灶44个(49%),良性病灶46个(51%)。病理确诊恶性病灶39个,其中原发性肝癌30个,非典型增生9个;良性病灶51个,其中再生结节26个,血管瘤9个,局限性脂肪变性10个,炎性坏死4个,腺瘤2个。超声造影诊断恶性病变敏感性为90%,特异性为80%,准确性82%。78例患者中血清甲胎蛋白增高19例,其中病理确诊肝细胞肝癌9例,不典型增生2例,再生结节5例,血管瘤3例。结论常规超声联合血清甲胎蛋白检查对甲胎蛋白阴性肝癌的诊断价值不大。超声造影是超声定性诊断肝脏高回声良恶性病变的敏感方法。
Objective To explore the value of contrast-enhanced ultrasound in the diagnosis of hyperechoic liver lesions. Methods The data of 90 hyperechoic lesions of 78 patients with suspected liver cancer underwent routine ultrasonography were retrospectively analyzed. The features of CEUS were analyzed, and the serum AFPs were newly diagnosed. Finally, the biopsy was performed under ultrasound guidance. Results 90 lesions were diagnosed by CEUS in 44 (49%) and benign (46) lesions (51%). Pathological diagnosis of 39 malignant lesions, of which 30 cases of primary liver cancer, atypical hyperplasia 9; 51 benign lesions, of which 26 regenerative nodules, hemangiomas 9, localized steatosis 10, 4 inflammatory necrosis , Adenoma 2. The sensitivity of ultrasound in the diagnosis of malignant lesions was 90%, specificity was 80% and accuracy was 82%. Among the 78 patients, there were 19 cases of elevated serum alpha-fetoprotein, including 9 hepatocellular carcinoma confirmed by pathology, 2 atypical hyperplasia, 5 regenerative nodules and 3 hemangiomas. Conclusion Conventional ultrasound combined with serum alpha-fetoprotein has little value in the diagnosis of AFP negative hepatocellular carcinoma. Ultrasonography is a sensitive method for the qualitative diagnosis of hyperechoic benign and malignant lesions in the liver by ultrasound.