CAJ | 학술논문

目的探讨超声造影在肝硬化增生结节与小肝癌鉴别诊断中的价值.方法 34例肝硬化合并小结节病灶患者行实时超声造影检查,18例20个病灶为小肝癌,16例18个病灶为增生结节,所有病例均经病理证实.观察两类病灶增强时相、类型及模式,并行定量参数比较研究.结果 ①小肝癌动脉相高增强,门脉相等或低增强,延迟相低增强较多见；肝硬化增生结节增强表现多样化,以三期等增强最多见,两者各时相增强程度比较差异有统计学意义(P＜0.05).②肝硬化结节与小肝癌多均匀增强,不均匀增强较少见,两者增强类型比较差异无统计学意义(P＞0.05).③小肝癌病灶中,11个为快进慢退型,9个为快进快退型；增生结节病灶中,1个为中晚期增强型,3个为早期延迟增强型,14个为同步增强型.④增生结节与同深度肝硬化组织各参数比较差异均无统计学意义(P ＞0.05).小肝癌与同深度肝硬化组织及增生结节比较,始增时间、达峰时间短,峰值强度高,曲线尖度大(P＜0.05).结论超声造影对肝硬化背景下增生结节和小肝癌的鉴别诊断具有重要价值.
목적 탐토초성조영재간경화증생결절여소간암감별진단중적개치.방법 34례간경화합병소결절병조환자행실시초성조영검사,18례20개병조위소간암,16례18개병조위증생결절,소유병례균경병리증실.관찰량류병조증강시상、류형급모식,병행정량삼수비교연구.결과 ①소간암동맥상고증강,문맥상등혹저증강,연지상저증강교다견；간경화증생결절증강표현다양화,이삼기등증강최다견,량자각시상증강정도비교차이유통계학의의(P＜0.05).②간경화결절여소간암다균균증강,불균균증강교소견,량자증강류형비교차이무통계학의의(P＞0.05).③소간암병조중,11개위쾌진만퇴형,9개위쾌진쾌퇴형；증생결절병조중,1개위중만기증강형,3개위조기연지증강형,14개위동보증강형.④증생결절여동심도간경화조직각삼수비교차이균무통계학의의(P ＞0.05).소간암여동심도간경화조직급증생결절비교,시증시간、체봉시간단,봉치강도고,곡선첨도대(P＜0.05).결론 초성조영대간경화배경하증생결절화소간암적감별진단구유중요개치.
Objective To evaluate the diagnostic value of contrast-enhanced ultrasound(CEUS) in regenerative nodules(RNs)and small hepatocellular carcinoma(sHCC).Methods Thirty-four cases of liver cirrhosis with small nodule were examined by CEUS.Among these cases,18 cases with 20 lesions were diagnosed s HCC,16 cases with 18 lesions were diagnosed RN eventually,all the diagnoses were confirmed by pathology.Perfusion characteristic and quantitative difference of RNs and sHCC were summarized.Results ①The majority of sHCC showed hyper-enhancement during the arterial phase,iso-enhancement or hypo-enhancement during the portal phase,hypo-enhancement during the late phase.The enhanced phase and degree of RNs were diverse,most of RNs showed iso enhancement during the three phases.The enhanced phase of two groups had significant difference(P ＜0.05).②The enhancement type of RNs and sHCC had no significant difference (P ＞ 0.05).③ 11 of 20 sHCC lesions showed contrast-enhancement pattern of "fast-in and slow-out",9 lesions were "fast-in and fast-out";among 18 RNs,1 lesion enhanced during the portal phase and the late phase,it didn't enhanced during the arterial phase,3 lesions started to enhanced at the late arterial phase,14 lesions were iso-enhancement during the three phases.④Comparison of parameters of RNs and the adjacent liver parenchyma had no significant difference(P ＞0.05).Compared with the adjacent liver parenchyma or RNs,the arrival time and peak time were shorter,the peak intensity and the curve sharpness were higher in sHCC (P ＜ 0.05).Conclusions CEUS is a useful method to distinguish RNs and sHCC in liver cirrhosis.