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中华医学超声杂志(电子版) ›› 2016, Vol. 13 ›› Issue (05) : 371 -377. doi: 10.3877/cma.j.issn.1672-6448.2016.05.010

所属专题: 文献

腹部超声影像学

肝血管瘤超声造影定量特征
吴剑1, 徐辉雄1,(), 郭乐杭1, 张一峰1, 孙丽萍1, 徐军妹1, 刘琳娜1, 刘畅1   
  1. 1. 200072 上海,同济大学附属第十人民医院超声医学科
  • 收稿日期:2015-11-16 出版日期:2016-05-01
  • 通信作者: 徐辉雄
  • 基金资助:
    上海市卫生局重点项目(20114003); 上海市人才发展资金项目(2012045); 教育部新世纪优秀人才支持计划项目(NCET-06-0723)

Characteristics of parametric imaging of contrast-enhanced ultrasound for hepatic hemangioma

Jian Wu1, Huixiong Xu1,(), Lehang Guo1, Yifeng Zhang1, Liping Sun1, Junmei Xu1, Linna Liu1, Chang Liu1   

  1. 1. Department of Ultrasonography, Tenth People's Hospital of Tongji University, Shanghai 200072, China
  • Received:2015-11-16 Published:2016-05-01
  • Corresponding author: Huixiong Xu
  • About author:
    Corresponding author: Xu Huixiong, Email:
引用本文:

吴剑, 徐辉雄, 郭乐杭, 张一峰, 孙丽萍, 徐军妹, 刘琳娜, 刘畅. 肝血管瘤超声造影定量特征[J/OL]. 中华医学超声杂志(电子版), 2016, 13(05): 371-377.

Jian Wu, Huixiong Xu, Lehang Guo, Yifeng Zhang, Liping Sun, Junmei Xu, Linna Liu, Chang Liu. Characteristics of parametric imaging of contrast-enhanced ultrasound for hepatic hemangioma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(05): 371-377.

目的

探讨肝血管瘤超声造影定量特征。

方法

选取2013年10月至2015年4月同济大学附属第十人民医院收治的肝血管瘤患者42例。38例经CT及磁共振成像证实,4例经手术病理证实为海绵状血管瘤。利用SonoLiver软件进行定量分析,以病灶与其周围正常肝实质的增强水平差值为参数进行动态血管模型(DVP)参数成像。分析肝血管瘤及病灶周围肝实质的峰值强度(Imax)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(mTT)、灌注指数(PI)及DVP曲线。采用t检验分别比较肝脏大血管瘤、肝脏小血管瘤与病灶周围正常肝实质、肝脏大血管瘤与肝脏小血管瘤、肝血管瘤中央部与边缘部Imax、RT、TTP、mTT、PI差异。

结果

肝脏大血管瘤、肝脏小血管瘤的Imax、PI均高于病灶周围正常肝实质,RT、TTP、mTT均短于病灶周围正常肝实质,且差异均有统计学意义(t值分别为6.467、-14.758、-9.772、-3.753、4.157,P均<0.05)。肝脏大血管瘤Imax高于肝脏小血管瘤,且差异有统计学意义(t=4.146,P<0.05);肝脏大血管瘤与肝脏小血管瘤RT、TTP、mTT、PI差异均无统计学意义。肝血管瘤中央部Imax高于肝血管瘤边缘部,RT、TTP均长于肝血管瘤边缘部,且差异均有统计学意义(t值分别为7.087、8.091、8.654,P<0.01或0.05);肝血管瘤中央部与边缘部mTT、PI差异均无统计学意义。肝血管瘤的DVP曲线及DVP参数图均可分为3种类型:Ⅰ型,消退型;Ⅱ型,未消退型;Ⅲ型:负向型。本组肝血管瘤患者DVP曲线、DVP参数图呈Ⅰ型、Ⅱ型、Ⅲ型分别为16例(16/42,38.1%)、20例(20/42,47.6%)、6例(6/42,14.3%)和15例(15/42,35.7%)、10例(10/42,23.8%)、17例(17/42,40.5%)。

结论

肝血管瘤的TTP和mTT短于病灶周围肝实质。肝脏大血管瘤的Imax和PI高于肝脏小血管瘤。肝血管瘤内边缘部RT及TTP比中央部快。DVP曲线可直观显示肝血管瘤与病灶周围肝实质血流灌注的差异。

Objective

To investigate the characteristics of parametric imaging of contrast-enhanced ultrasound (CEUS) in evaluating hepatic hemangioma.

Methods

Totally 42 cases of patients with hemangioma were selected from October 2013 to April 2015 in the Tenth People's Hospital of Tongji University. Thirty-eight cases were confirmed by CT and magnetic resonance imaging (MRI), and 4 cases were confirmed by surgery pathology for cavernous hemangioma. SonoLiver CAP software was used to quantitatively analyze the CEUS and calculate dynamic vascular imaging model parameters (DVP) based on the enhancement difference between lesions and surrounding normal liver parenchyma. The peak intensity (Imax), the rise time (RT), time to peak (TTP), mean transit time (mTT), perfusion index (PI) and DVP curve of hemangioma and surrounding parenchyma were analyzed. T test was used to compare the differences of Imax, RT, TTP, mTT and PI among the large liver hemangioma, small liver hemangioma and surrounding normal liver parenchyma, between large liver hemangioma and small liver hemangioma, and between the edge and central part of liver hemangioma, respectively.

Results

Imax and PI in both large hemangioma and small hemangioma were higher than that in normal liver parenchyma; RT, TTP and mTT were shorter in the surrounding normal liver parenchyma, and the differences were statistically significant. Imax in large liver hemangioma was higher than that in small hemangioma, and the difference was statistically significant. The difference of RT, TTP, mTT and PI between large hemangioma and small hemangioma were not statistically significant. Imax in central part was higher than that in the edge part of liver hemangioma. RT, TTP in central part were also longer than that in edge part, and the difference had statistical significance. mTT and PI in both large and small hemangioma had no significant difference. DVP curves and DVP parameter figures of liver hemangioma can be divided into three types: type Ⅰ, positive model with gradual washout; type Ⅱ, positive model with no washout; type Ⅲ, negative model. For DVP curves and DVP parameter , type Ⅰ, type Ⅱ and type Ⅲ respectively had 16 cases (16/42, 38.1%), 20 cases (20/42, 47.6%), 6 cases (6/42, 14.3%) and 15 cases (15/42, 35.7%), 10 cases (10/42, 23.8%), 17 cases (17/42, 40.5%).

Conclusions

TTP and mTT of hemangiomas was shorter than the surrounding liver parenchyma by using contrast-enhanced ultrasound imaging parameters. The Imax and PI in large hemangioma was higher than that in small hemangioma. The RT and TTP in hemangioma edges was faster than that in central parts. The difference of blood perfusion in the liver hemangioma and surrounding liver parenchyma could be shown by DVP curve.

图1,2 肝血管瘤二维灰阶超声声像图(图1)及彩色多普勒超声声像图(图2)
图3,4 肝血管瘤参数成像后的DVP参数图。DVP值代表病灶与周围肝实质的增强水平差值。越偏向红/黄色表示回声强度越强;越偏向黑/蓝色表示回声强度越弱。绿圈区为感兴趣区,紫红圈区为正常肝实质对照区
表1 肝脏大血管瘤与病灶周围肝实质各参数比较(±s
表2 肝脏小血管瘤与病灶周围肝实质各参数比较(±s
表3 肝脏大血管瘤与肝脏小血管瘤各参数比较(±s
表4 肝血管瘤中央部与边缘部各参数比较(±s
图5~7 3种DVP曲线类型。图5 为消退型,曲线开口向下起始点位于原点,下降支下降至X轴以下。病灶起始增强高于肝实质,造影终末期消退并低于肝实质;图6 为未消退型,曲线呈开口向下的类抛物线,下降支未下降至X轴以下,病灶增强模式由强而弱并一直高于肝实质;图7 为负向型,曲线完全位于X轴下方。病灶增强模式始终低于肝实质
图8~10 肝血管瘤DVP参数图的3个时期。图8 示动脉相为红色/黄色填充;图9 示门脉相为红色/黄色减退;图10 示延迟相为黑色/红色填充
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