【摘要】：目的 本研究主要目的是探討超聲造影診斷原發(fā)性肝癌特征性表現(xiàn)及與病理分化相關(guān)性研究，旨在確立超聲造影技術(shù)定性診斷肝癌的重要臨床價(jià)值。 資料與方法 對(duì)我院2010年1月至2013年12月472例肝占位性病變（病灶直徑0.6-8.4cm，患者多個(gè)病灶時(shí)取直徑最大病灶），其中男308例，女164例，年齡23-78歲，平均50.7±15.3歲,進(jìn)行超聲造影檢查，并與病理相對(duì)照。 超聲診斷儀器是Siemens Sequoia512，探頭4C-1，頻率1-4MHz，利用超聲造影對(duì)比脈沖序列（contrast pulse sequencing，CPS）成像技術(shù)；PhilipsiU22超聲儀，探頭頻率1-5MHz，具備低機(jī)械指數(shù)（0.04-0.10）脈沖反向諧波成像技術(shù)。超聲造影劑為意大利Bracco公司生產(chǎn)的SonoVue造影劑。超聲造影全過(guò)程實(shí)時(shí)全程錄像的動(dòng)態(tài)存儲(chǔ)技術(shù)，造影后逐幀分析研究病灶內(nèi)造影劑開(kāi)始增強(qiáng)時(shí)間、達(dá)峰時(shí)間、開(kāi)始廓清時(shí)間，病灶增強(qiáng)與廓清方式、形態(tài)等，同時(shí)將超聲造影灌注特征及增強(qiáng)模式與其病理結(jié)果對(duì)比分析，造影診斷至少由2名資深超聲診斷醫(yī)師獨(dú)立進(jìn)行分析判斷。完整的超聲造影增強(qiáng)過(guò)程分為3個(gè)時(shí)相[1]：動(dòng)脈期（10s~30s）、門(mén)脈期（31s~120s）、延遲期（121s~360s）。 結(jié)果 1．472例肝占位性病變中經(jīng)病理證實(shí)的惡性腫瘤267例，良性腫瘤205例。 1.1.原發(fā)性肝癌超聲造影的特征性表現(xiàn)：病灶動(dòng)脈期呈快速整體不均質(zhì)增強(qiáng)，門(mén)脈期快速廓清，其起始增強(qiáng)時(shí)間、開(kāi)始廓清時(shí)間并總持續(xù)時(shí)間均短于良性腫瘤（P＜0.01）。其中肝細(xì)胞性肝癌多表現(xiàn)為“快進(jìn)快出”，即動(dòng)脈期球狀整體快速增強(qiáng)、門(mén)脈期快速廓清；膽管細(xì)胞性肝癌多表現(xiàn)為“快進(jìn)更快出”，動(dòng)脈期樹(shù)枝狀快速增強(qiáng)，廓清時(shí)間更快于肝細(xì)胞性肝癌。 1.2.肝良性腫瘤特征性表現(xiàn)多為“慢進(jìn)慢出”、“快進(jìn)慢出”“無(wú)增強(qiáng)”等，肝血管瘤向心性增強(qiáng)，局灶性結(jié)節(jié)增生放射狀或泉涌狀增強(qiáng)，但門(mén)脈晚期、延遲期廓清均慢于周邊肝組織；炎性假瘤以無(wú)增強(qiáng)為主要特征，肝硬化結(jié)節(jié)與周邊肝組織同步顯影。 2.超聲造影發(fā)現(xiàn)并確定原發(fā)性肝癌4種血供分型 2.1．肝動(dòng)脈單獨(dú)血供或以肝動(dòng)脈血供為主型，占79.8%（213/267）其表象為病灶均在動(dòng)脈期開(kāi)始增強(qiáng)，呈球形狀快速填充，門(mén)脈期肝實(shí)質(zhì)開(kāi)始增強(qiáng)，病灶開(kāi)始快速廓清，呈等或低回聲，延遲期病灶回聲低于周邊肝組織。 2.2．肝動(dòng)脈和門(mén)靜脈雙重血供型，占13.5%（36/267）其表象為動(dòng)脈期病灶開(kāi)始增強(qiáng)，門(mén)脈期肝實(shí)質(zhì)開(kāi)始增強(qiáng)，而病灶持續(xù)增強(qiáng)，延遲期病灶開(kāi)始緩慢廓清。 2.3．肝動(dòng)脈和門(mén)靜脈雙重血供且同時(shí)存在動(dòng)靜脈瘺型，占5.2%（14/267）其表象為動(dòng)脈期病灶即開(kāi)始增強(qiáng)，門(mén)脈期病灶持續(xù)增強(qiáng)，，延遲期由于動(dòng)靜脈瘺的存在，病灶始終與周?chē)谓M織同步顯影。 2.4.門(mén)靜脈單獨(dú)血供或以門(mén)靜脈血供為主型，占1.5%（4/267）其表象為動(dòng)脈期病灶內(nèi)造影劑增強(qiáng)不明顯，門(mén)脈期病灶內(nèi)造影劑開(kāi)始緩慢增強(qiáng)，延遲期早期邊肝組織同步顯影，延遲期晚期病灶內(nèi)造影劑低于周邊肝組織。 3.超聲造影診斷原發(fā)性肝癌的敏感性、特異性、準(zhǔn)確性與病理診斷相對(duì)照，其結(jié)果分別為：98.9%(264/267)、95.6%(196/205)、97.4%（460/472），約登指數(shù)、陽(yáng)性似然比、陰性似然比分別為：0.94、22.5和0.012。 4.原發(fā)性肝癌超聲造影廓清時(shí)間差異表現(xiàn)與病理分化程度相關(guān)性對(duì)照具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 結(jié)論 超聲造影技術(shù)能顯著提高肝臟良惡性腫瘤診斷與鑒別診斷的準(zhǔn)確性，并能確定肝癌血供分型，為臨床肝癌早期正確的診斷和治療方案的選擇、有效規(guī)范治療具有重要價(jià)值，同時(shí)為腫瘤分化程度的界定提供了影像學(xué)參考依據(jù)。
[Abstract]:objective
The purpose of this study was to investigate the characteristic features of contrast-enhanced ultrasonography (CEUS) in the diagnosis of primary hepatocellular carcinoma (PHC) and its correlation with pathological differentiation.
Data and methods
From January 2010 to December 2013, 472 cases of hepatic space-occupying lesions (lesions with a diameter of 0.6-8.4 cm and the largest diameter of lesions) were examined by contrast-enhanced ultrasonography (CEUS), including 308 males and 164 females, aged 23-78, with an average age of 50.7 (+ 15.3).
Ultrasound diagnostic instrument is Siemens Sequoia 512, probe 4C-1, frequency 1-4MHz, using contrast pulse sequencing (CPS) imaging technology; Philipsi U22 ultrasonic instrument, probe frequency 1-5MHz, with low mechanical index (0.04-0.10) pulse reverse harmonic imaging technology. NoVue Contrast Agent. Dynamic storage technology of real-time full-range video recording during the whole process of contrast-enhanced ultrasound. After contrast-enhanced, frame-by-frame analysis of contrast media in the lesion start enhancement time, peak time, start clearance time, lesion enhancement and clearance mode, morphology, etc. At the same time, contrast-enhanced ultrasound perfusion characteristics and enhancement mode were compared with their pathological results, contrast-enhanced diagnosis. The complete contrast-enhanced ultrasound was divided into three phases: arterial phase (10s-30s), portal phase (31s-120s) and delayed phase (121s-360s).
Result
In 1.472 cases of hepatic space occupying lesions, 267 cases were confirmed by pathology, 205 cases were benign tumors.
1.1 Contrast-enhanced ultrasonography of primary hepatocellular carcinoma (PHC) showed rapid global heterogeneous enhancement in the arterial phase, rapid clearance in the portal phase, shorter initial enhancement time, initial clearance time and total duration than benign tumors (P < 0.01). Strong, portal phase of rapid clearance; bile duct cell hepatocellular carcinoma mostly manifested as "fast in and out", arterial phase dendritic rapid enhancement, clearance time faster than hepatocellular carcinoma.
1.2. Most of the benign hepatic tumors were characterized by "slow in and slow out", "fast in and slow out", "no enhancement" and so on. The hepatic hemangioma was centripetal enhancement, focal nodular hyperplasia was radial or spring-like enhancement, but the clearance of late portal vein and delayed phase was slower than that of peripheral liver tissue. Synchronous tissue development.
2. contrast-enhanced ultrasound found and identified 4 types of blood supply for primary liver cancer.
2.1. Hepatic artery alone or hepatic artery blood supply as the main type, accounted for 79.8% (213/267) of the lesions were enhanced in the arterial phase, the rapid filling in a spherical shape, portal phase hepatic parenchyma began to strengthen, lesions began to clear quickly, showed isoechoic or hypoechoic, delayed lesions echo lower than the surrounding liver tissue.
2.2 The hepatic artery and portal vein double blood supply type, accounting for 13.5% (36/267) of the lesions in the arterial phase began to enhance, the hepatic parenchyma in the portal phase began to strengthen, and the lesions continued to strengthen, the delayed lesions began to clear slowly.
2.3. The hepatic artery and portal vein had double blood supply and arteriovenous fistula, accounting for 5.2% (14/267). The lesions in the arterial phase began to strengthen, and the lesions in the portal phase continued to strengthen. The lesions in the delayed phase were always developed synchronously with the surrounding liver tissue due to the presence of arteriovenous fistula.
2.4. Portal vein blood supply alone or portal vein blood supply as the main type, accounting for 1.5% (4/267) of the appearance of intra-arterial contrast media enhancement was not obvious, intra-portal contrast media began to slowly enhance, early delayed peripheral liver tissue synchronous imaging, late delayed lesions contrast media lower than peripheral liver tissue.
3. The sensitivity, specificity and accuracy of contrast-enhanced ultrasound in the diagnosis of primary hepatocellular carcinoma were 98.9% (264/267), 95.6% (196/205), 97.4% (460/472), Jordan index, positive likelihood ratio, negative likelihood ratio were 0.94, 22.5 and 0.012, respectively.
4. The correlation between the clearance time of contrast-enhanced ultrasound and the degree of pathological differentiation was statistically significant (P<0.05).
conclusion
Contrast-enhanced ultrasonography can significantly improve the accuracy of diagnosis and differential diagnosis of benign and malignant liver tumors, and determine the blood supply classification of hepatocellular carcinoma. It is of great value for the correct early diagnosis and treatment of hepatocellular carcinoma, and for the effective standardization of treatment.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R445.1;R735.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 司芩;黃聲稀;仝威;錢(qián)曉莉;呂校平;黃艷麗;;肝癌及門(mén)靜脈癌栓血供灌注特征的彩超與超聲造影研究[J];東南國(guó)防醫(yī)藥;2011年01期

2 張拾命;黃道中;;超聲造影對(duì)良惡性肝臟局灶性病變的鑒別診斷價(jià)值[J];放射學(xué)實(shí)踐;2011年05期

3 王曉東;梁群興;趙萍;;超聲造影和彩色多普勒超聲在原發(fā)性肝細(xì)胞肝癌診斷中的應(yīng)用[J];廣東醫(yī)學(xué);2013年12期

4 K.Numata;M.Morimoto;M.Kondo;S.Takebayashi;M.Okada;尚全良;;肝臟局灶腫瘤:3D perflubutane微泡對(duì)比劑增強(qiáng)超聲與3D增強(qiáng)多層CT特征[J];國(guó)際醫(yī)學(xué)放射學(xué)雜志;2009年03期

5 蔣映豐;周啟昌;朱才義;;超聲造影在肝臟良惡性腫瘤鑒別診斷中的價(jià)值[J];中南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2012年01期

6 楊龍;王綺;吳剛;袁建軍;郝遠(yuǎn)瑞;田建國(guó);;原發(fā)性肝癌超聲造影灌注改變與生物學(xué)特性關(guān)系研究[J];中華實(shí)用診斷與治療雜志;2010年05期

7 王凹弟;;原發(fā)性肝癌超聲造影特征與病理對(duì)照研究[J];中華保健醫(yī)學(xué)雜志;2011年01期

8 袁建華,陳方宏,俞文強(qiáng),劉子江;間接門(mén)靜脈數(shù)字減影造影對(duì)肝癌血供的研究[J];介入放射學(xué)雜志;1999年02期

9 李春雨;黃麗萍;張宏宇;李紅丹;尹帥;;不同組織病理學(xué)類(lèi)型肝細(xì)胞癌超聲造影定量血流灌注參數(shù)的差異[J];中國(guó)介入影像與治療學(xué);2012年06期

10 廖繼安;王愛(ài)玉;張化誠(chéng);金夏祥;;小肝癌超聲造影特征與病理組織學(xué)分析研究[J];臨床超聲醫(yī)學(xué)雜志;2012年02期

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