【摘要】：肝臟的局灶性病變很常見,分為惡性局灶性病變和良性局灶性病變兩大類。常見的惡性局灶性病變包括肝細胞性肝癌、膽管細胞性肝癌和轉(zhuǎn)移性肝癌等,良性局灶性病變包括肝血管瘤、局灶性病變樣增生、肝腺瘤、肝膿腫、炎性假瘤、肝結(jié)核等。常規(guī)彩色多普勒超聲由于無輻射、無創(chuàng)傷、方便快捷、價格低廉、適用性廣等優(yōu)點成為肝臟檢查的首選方法。但由于肝臟局灶性病變的常規(guī)彩色多普勒超聲上的表現(xiàn)多樣,有很多相似之處,所以很難鑒別。超聲造影(Contrast-enhanced Ultrasound,CEUS)能客觀地反映組織微血管的血流灌注情況,大大的提高超聲診斷肝臟局灶性病變的敏感性和特異性[1]。研究目的:通過研究不同類型的肝局灶性病變的超聲造影表現(xiàn),探討超聲造影在肝局灶性病變診斷及鑒別診斷中的應(yīng)用價值。研究方法:回顧分析2014年1月至2016年1月在我院經(jīng)病理證實或由增強CT或MRI并隨訪12個月以上證實的93例肝局灶性病變病人超聲造影結(jié)果,記錄病人的年齡、性別、臨床檢驗學(xué)指標;評估病人肝臟的整體情況,有無脂肪肝或肝硬化;記錄二維超聲中病灶的大小、數(shù)目、位置、邊界,內(nèi)部回聲及彩色多普勒血流情況;分析病灶的超聲造影圖像特征,記錄動脈期、門脈期、延遲期的增強特點,記錄開始增強的時間,達峰時間、消退時間。結(jié)果:93例肝局灶性病變病人共119個病灶,肝右葉71個,肝左葉48個,肝細胞性肝癌25例28個病灶,膽管細胞性肝癌1例1個病灶,轉(zhuǎn)移性肝癌11例18個病灶,肝血管瘤19例26個病灶,肝局灶性病變樣增生16例20個病灶,肝腺瘤6例8個病灶,肝膿腫12例14個病灶,肝結(jié)核3例4個病灶。這些病灶造影后的增強方式隨時間變化而動態(tài)改變。大部分病灶在動脈期、門脈期及延遲期有其特異性的表現(xiàn)。結(jié)論:超聲造影能客觀地反映組織微血管的血流灌注情況,對肝臟局灶性病變鑒別診斷有重要價值;肝臟超聲造影能彌補常規(guī)超聲的不足,檢出常規(guī)超聲未發(fā)現(xiàn)的病灶,提高肝局灶性病變的診斷準確性。
[Abstract]:Focal liver lesions are common and can be classified into malignant focal lesions and benign focal lesions. Common malignant focal lesions include hepatocellular carcinoma, cholangiocarcinoma and metastatic liver cancer. Benign focal lesions include hepatic hemangioma, focal lesion like hyperplasia, hepatic adenoma, liver abscess, inflammatory pseudotumor, hepatic tuberculosis and so on. Conventional color Doppler ultrasound has become the preferred method for liver examination because of its advantages of no radiation, no injury, convenience, low price and wide applicability. However, it is difficult to differentiate focal liver lesions due to the variety of conventional color Doppler ultrasound findings and many similarities. Contrast-enhanced ultrasound (Contrast-enhanced Ultrasound,CEUS) can objectively reflect the blood flow perfusion of tissue microvessels, and greatly improve the sensitivity and specificity of ultrasound in the diagnosis of focal liver lesions [1]. Objective: to investigate the value of contrast-enhanced ultrasonography in the diagnosis and differential diagnosis of focal hepatic lesions. Methods: from January 2014 to January 2016, 93 patients with focal hepatic lesions confirmed pathologically or by enhanced CT or MRI and followed up for more than 12 months were retrospectively analyzed. The age and sex of the patients were recorded. Clinical laboratory indexes; The size, number, location, boundary, internal echo and color Doppler flow of the lesions in two-dimensional ultrasound were recorded. The contrast-enhanced features of the lesions were analyzed, and the enhancement characteristics of arterial phase, portal phase and delayed phase were recorded, and the time of beginning enhancement, peak time and extinction time were recorded. Results: there were 119 lesions in 93 patients with focal hepatic lesions, including 71 lesions in the right lobe of liver, 48 lesions in Zuo Ye, 28 lesions in 25 cases of hepatocellular carcinoma, 1 case in 1 case of cholangiocarcinoma and 18 lesions in 11 cases of metastatic liver cancer. There were 26 lesions in 19 cases of hepatic hemangioma, 20 lesions in 16 cases of hepatic focal lesion like hyperplasia, 8 lesions in 6 cases of hepatic adenoma, 14 lesions in 12 cases of liver abscess and 4 lesions in 3 cases of hepatic tuberculosis. The enhancement patterns of these lesions changed dynamically over time. Most of the lesions have specific manifestations in arterial phase, portal phase and delayed phase. Conclusion: contrast-enhanced ultrasound can objectively reflect the blood flow perfusion of tissue microvessels and has important value in differential diagnosis of focal liver lesions. Liver contrast-enhanced ultrasound can make up for the deficiency of conventional ultrasound, detect the undetected lesions of conventional ultrasound, and improve the diagnostic accuracy of focal hepatic lesions.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R575

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