探讨超声造影（CEUS）联合磁共振成像（MRI）实时导航技术在小肝癌诊断中的应用。

收集2008年1月至2015年6月复旦大学附属中山医院门诊及住院的临床疑诊为小肝癌（直径小于20 mm）的患者50例，共50个病灶，所有患者在常规超声检查未发现病灶，而增强MRI均提示有小肝癌。采用GE公司LOGIQ E9超声诊断仪，配备超声造影与MRI导航技术。超声造影采用低机械指数下实时灰阶超声造影（MI 0.05~0.12），每次造影经肘静脉团注1.5~2.4 ml造影剂SonoVue。

所有病灶均经手术、活检或其他影像学检查证实为肝癌，其中原发性肝癌45个，转移性肝癌5个。实时导航超声造影时，50例患者均成功完成图像融合，融合成功率100%，平均融合时间为（9.1±0.5）min。在50个病灶中，常规超声造影发现15个病灶（30%，15/50），实时导航超声造影检出48个病灶（96%，48/50），两者比较差异具有统计学意义（Z=1.73，P<0.05）。在实时导航超声造影中，46个（92.0%，46/50）病灶表现为动脉期快速增强，4个病灶（8%，4/50）呈同步增强；28个病灶在门脉期呈等回声（56%，28/50），超声造影联合MRI实时导航成像技术检出48个病灶（96%，48/50），2个未能显示的病灶经人工胸水后再次实时导航顺利检出。实时导航超声造影对本组小肝癌的检出率及诊断准确性为100%。

实时导航超声造影可显著提高小肝癌检出率和诊断准确性。

To evaluate whether volume navigation guided real time contrast-enhanced ultrasound (CEUS) can be performed effectively in diagnosis of small malignant hepatic lesions.

Fifty patients with suspected small malignant hepatic lesions was included in this study. Tumor diameters were small than 20 mm. All lesions were detected by contrast-enhanced MR imaging (MRI) but were undetectable on conventional ultrasound. LOGIQ E9 ultrasound system (GE Healthcare) equipped with volume navigation system was used to fuse CEUS and MRI images. CEUS was performed using real time contrast harmonic imaging at a low MI 0.05-0.12 with a 1.5-5.0 MHz probe. For each imaging session, a dose of 1.5-2.4 ml SonoVue was injected as a quick bolus into the antecubital vein.

Consequently, fifty small malignant hepatic lesions in 50 patients were included in this study. The final diagnoses were confirmed by operation, percutaneous biopsy or radiological data, including 45 primary and 5 metastatic hepatic carcinomas. Image fusions were conducted successfully in all 50 lesions and the technical success rate was 100%. The average fusion time was (9.1±0.5) min. The detection rate of small malignant hepatic lesions using CEUS/MRI imaging fusion (96.0%, 48/50) was significantly higher than that of conventional CEUS (30.0%, 15/50) (Z=1.73, P<0.05). After injection of SonoVue, 46 (92.0%, 46/50) small malignant hepatic lesions displayed rapid wash-in pattern in the arterial phase of CEUS/MRI imaging fusion, and 4 lesions (8.0%, 4/50) showed synchronous enhancement. In the portal venous phase, 28 (56.0%, 28/50) lesions showed iso-enhancement comparing to the surrounding liver parenchyma. CEUS/MRI imaging fusion detected 48 lesions (96.0%, 48/50). After artificial pleural effusion, another 2 nodules were clearly detected. In our current research, the detection rate and diagnostic accuracy of CEUS/MRI imaging fusion were 100%.

Imaging fusion combining CEUS with MRI is a promising technique to improve the detection rate and accurate diagnosis of small malignant hepatic lesions.