本文選題：FLL + 3D-CEUS�。� 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討肝臟局灶性病變（FLL）的三維超聲造影（3D-CEUS）聲像特征及其臨床應(yīng)用價值。 方法：使用PHILIPS IU22超聲診斷儀、C5-1凸陣探頭、V6-2三維容積探頭以及聲諾維超聲造影劑，經(jīng)肘靜脈團(tuán)注法對127例二維超聲造影（2D-CEUS）檢查動脈相早期有增強(qiáng)的FLL進(jìn)行3D-CEUS檢查。2D-CEUS檢查觀察各局灶性病變的動脈相增強(qiáng)方式及增強(qiáng)模式，3D-CEUS檢查經(jīng)處理后觀察病灶動脈相增強(qiáng)方式、病灶內(nèi)部結(jié)構(gòu)，以及滋養(yǎng)血管數(shù)目、分布及形態(tài)等，分析兩種檢查方法的觀察參數(shù)對病灶性質(zhì)的診斷價值。以P＜0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果： 1、FLL3D-CEUS典型聲像表現(xiàn)：本文75例肝細(xì)胞性肝癌(HCC)中有74例（98.7%）3D-CEUS表現(xiàn)為動脈相均勻/不均性整體增強(qiáng)（實心球樣改變）,病灶滋養(yǎng)血管數(shù)目隨體積增大而增加，大于1cm HCC供養(yǎng)血供呈多源性向病灶內(nèi)部延伸的紊亂滋養(yǎng)血管；31例肝血管瘤（HCH）均（100%）表現(xiàn)為動脈相環(huán)狀增強(qiáng)或向心性增強(qiáng)（空心球樣改變）伴周邊一側(cè)結(jié)節(jié)樣聚集規(guī)則滋養(yǎng)血管；11例肝局灶性結(jié)節(jié)性增生（FNH）有10例（90.9%）表現(xiàn)為動脈相早期病灶邊緣一支滋養(yǎng)血管進(jìn)入病灶內(nèi)部達(dá)中心呈放射狀分支離心性增強(qiáng)；7例肝膿腫表現(xiàn)為病灶內(nèi)部不均勻整體增強(qiáng)及該區(qū)域正常血管向病灶內(nèi)部延伸，血管形態(tài)規(guī)整；2例肝血管周上皮細(xì)胞樣腫瘤（PEC）表現(xiàn)為動脈相整體增強(qiáng)，病灶周邊多源性紊亂滋養(yǎng)血管，但未見向病灶內(nèi)部延伸；1例肝淋巴瘤（PHL）動脈相整體增強(qiáng)及周邊粗大滋養(yǎng)血管交錯并平直延伸至病灶內(nèi)部。 2、FLL2D-CEUS不典型病例的3D-CEUS聲像表現(xiàn)：本文HCC、HCH及FNH共117例，其中16例（16/117）2D-CEUS聲像表現(xiàn)不典型，這16例中有15例（93.8%）具有典型3D-CEUS聲像表現(xiàn)。（1）本組75例HCC有8例（10.7%）2D-CEUS表現(xiàn)不典型，其中3例動脈相增強(qiáng)方式呈環(huán)狀增強(qiáng)，3D-CEUS仍可見周邊多源性向病灶內(nèi)部延伸的紊亂滋養(yǎng)血管；5例增強(qiáng)模式為不出，3D-CEUS均呈現(xiàn)出典型HCC聲像改變。（2）本組31例HCH有5例（16.1%）2D-CEUS表現(xiàn)不典型，其中4例為動脈相整體增強(qiáng)，另1例為動脈相環(huán)狀增強(qiáng)伴快出，這5例HCH3D-CEUS均呈現(xiàn)出典型HCH聲像改變。（3）本組11例FNH有3例（27.3%）2D-CEUS動脈相整體增強(qiáng)，未見離心性增強(qiáng)過程，其中有2例3D-CEUS可見動脈相早期可見典型FNH3D-CEUS特征。 3、3D-CEUS對HCC病灶的滋養(yǎng)血管檢出率（100%）顯著高于2D-CEUS（74.7%，56/75）。HCC病灶大小與滋養(yǎng)血管檢出數(shù)呈正相關(guān)（P＜0.05，r=0.625）；而病灶分化程度與滋養(yǎng)血管數(shù)目間無明顯相關(guān)（P＞0.05）。 結(jié)論： 本組FLL各有其獨特的3D-CEUS聲像特征，主要表現(xiàn)在動脈相增強(qiáng)方式及滋養(yǎng)血管分布及形態(tài)方面的差異。3D-CEUS病灶滋養(yǎng)血管的檢出率及顯示質(zhì)量優(yōu)于2D-CEUS。肝臟3D-CEUS提高了對2D-CEUS不典型病例的超聲鑒別診斷能力。在2D-CEUS基礎(chǔ)上行肝臟3D-CEUS檢查，，對提高FLL的定性診斷具有重要的臨床應(yīng)用價值。
[Abstract]:Objective: to investigate the sonographic features of three dimensional contrast-enhanced ultrasonography (3D CEUS3 D) and its clinical value in focal hepatic lesions (FLLL). Methods: V6-2 three-dimensional volume probe and sonovir ultrasound contrast medium were used in PHILIPS IU22 ultrasonic diagnostic instrument. Two-dimensional contrast-enhanced FLL (2D-CEUS) was performed in 127 patients with early arterial phase enhancement by cubital venous mass injection. The arterial phase enhancement mode of each focal lesion was observed by 3D-CEUS, and the arterial phase enhancement mode was observed by contrast-enhanced 3D-CEUS. The internal structure of the lesion, the number, distribution and morphology of the trophoblastic vessels were analyzed. The diagnostic value of the observation parameters of the two methods in the diagnosis of the lesions was analyzed. The difference was statistically significant (P < 0.05). Results: 1FLTL3D-CEUS: 74 out of 75 cases of hepatocellular carcinoma (HCC) showed homogeneous / uneven enhancement of the arterial phase (solid globular changes), and the number of trophoblastic vessels increased with the increase of volume. In 31 patients with hepatic hemangioma, 31 patients with hepatic hemangioma were presented with annular enhancement or concentric enhancement (hollow ball like change) with peripheral nodular aggregation. Of the 11 cases of hepatic focal nodular hyperplasia (FNH), 10 cases presented as follows: early arterial phase, the edge of the lesion, a trophoblastic vessel entering the center of the lesion, centrifugal enhancement of radial branches, and 7 cases of liver abscess presented as intra focus. The normal blood vessels in the region extended to the inner part of the lesion. In 2 cases of hepatic perivascular epithelioid tumor (PECs), the arterial phase was enhanced as a whole, and the peripheral blood vessels were nourished by multi-source disorder. However, no extension to the lesion was seen in 1 case of hepatic lymphoma. The whole enhancement of PHL artery and the interlacing of the peripheral coarse nourishing vessels extended to the lesion. 2FLTL2D-CEUS: there were 117 cases of HCH and FNH in this study, of which 16 cases were atypical in 16 / 117D CEUs, 15 of them had typical 3D-CEUS sonographic manifestations.) of the 75 cases of HCC, 8 cases were 10.7D-CEUS. 3D-CEUS was still seen in 3 cases of arterial phase enhancement. 5 cases showed typical changes of HCC image. 5 cases of 31 cases of HCH showed atypical findings of 16.1% and 2D-CEUS. Among them, 4 cases were arterial phase enhancement, the other 1 case was arterial phase annular enhancement with rapid exit. All the 5 cases of HCH3D-CEUS showed typical changes of HCH image.) in 11 cases of FNH, 3 cases of FNH showed the whole enhancement of arterial phase of 27.3D CEUS, but no process of eccentric enhancement. Typical FNH3D-CEUS features were found in 2 cases of 3D-CEUS at the early stage of arterial phase. The positive correlation between the size of the lesions and the number of trophoblastic vessels was significant (P < 0.05), but there was no significant correlation between the degree of lesion differentiation and the number of trophoblastic vessels (P > 0.05). Conclusion: Each of the FLL had its unique characteristics of 3D-CEUS sonography, mainly manifested in the difference of arterial phase enhancement mode and the distribution and morphology of the trophoblastic vessels. 3The detection rate and the display quality of the lesion nourishing vessels were better than 2D-CEUSs. Liver 3D-CEUS improves the ability of ultrasonic differential diagnosis in atypical cases of 2D-CEUS. Liver 3D-CEUS examination on the basis of 2D-CEUS has important clinical application value in improving the qualitative diagnosis of FLL.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1

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