探讨肝包膜结核的超声造影表现特点。

回顾性分析2008年12月至2015年10月杭州市红十字会医院经超声引导下穿刺活检或手术病理证实为肝包膜结核的患者共48例，对48例肝包膜结核患者的71个病灶进行常规超声及超声造影检查，分析其位置、形态、大小、回声和增强时相、强度及模式等特征。

肝包膜结核常位于肝脏膈面包膜（54/71，76.1%），形态以梭形多见（59/71，83.1%），常呈混合回声（48/71，67.6%）。根据病灶与肝包膜的关系将肝包膜结核分为2种类型，Ⅰ型表现为病灶与肝实质接触处肝包膜连续性完整（37/71，52.1%），Ⅱ型表现为病灶与肝实质接触处肝包膜连续性中断（Ⅱa型，20/71，28.2%）或完全消失（Ⅱb型，14/71，19.7%）。超声造影示63个（88.7%）病灶表现为动脉期高增强，平均增强起始时间为（12.5±2.2）s（范围为9~17 s），达峰时间为（28.4±3.8）s（范围为22~35 s），门脉期及延迟期病灶呈等增强或低增强，有8个（11.3%）病灶表现为超声造影全程无增强。按峰值强度时病灶回声不同可分为4种表现：无增强（8/71，11.3%），环形增强（29/71，40.8%），不均匀增强（24/71，33.8%），均匀增强（10/71，14.1%）。本研究中不同类型的肝包膜结核超声造影表现差异有统计学意义（P<0.01）。

肝包膜结核超声造影表现以环形增强及不均匀增强多见，超声造影可显示肝包膜结核的血流灌注情况，在肝包膜结核的诊断中具有重要参考价值。

To investigate the characteristics of contrast-enhanced ultrasound in hepatic capsule tuberculosis.

Forty-eight hepatic capsule tuberculosis patients who proved by ultrasound-guided needle biopsy or surgical pathology from Hangzhou Red Cross Hospital from Dec 2008 to Oct 2015 were retrospective analyzed. Totally 71 lesions of 48 hepatic capsule tuberculosis patients were examined by both routine and contrast-enhanced ultrasound to analyze their characteristics of location, shape, size, echo and enhanced phase, intensity and mode etc.

Hepatic capsule tuberculosis was commonly displayed on hepatic diaphragmatic surface capsule (54/71, 76.1%) with fusiform shape (59/71, 83.1%) and hybrid echo (48/71, 67.6%) mostly. Hepatic capsule tuberculosis was divided into two types based on the relations between lesion and hepatic capsule. Type Ⅰ was performed to be the integrated continuity of hepatic capsule at the boundary of lesion and liver (37/71, 52.1%). Type Ⅱ was performed to be interrupted continuity of hepatic capsule at the boundary of lesion and liver (Type Ⅱa, 20 cases, 28.2%) or disappearance (TypeⅡb, 14 cases, 19.7%). Sixty-three lesions (88.7%) were performed to be hyper-enhanced in arterial phase by contrast-enhanced ultrasound. The average starting time of enhancement was (12.5±2.2) s (range 9-17 s). The average peak time was (28.4±3.8) s (range 22-35 s). Lesions in portal phase and delay phase were showed mid-enhanced or low-enhanced, and 8 cases (11.3%) were showed non-enhanced by contrast-enhanced ultrasound all the time. Lesion echo could be divided into 4 performances according to peak intensity: non-enhancement (8 cases, 11.3%), annular enhancement (29 cases, 40.8%), nonhomogeneous enhancement (24 cases, 33.8%) and homogeneous enhancement (10 cases, 14.1%). Differences between different results of hepatic capsule tuberculosis by contrast-enhanced ultrasound were significantly statistical (P<0.01).

Hepatic capsule tuberculosis is mostly performed to be annular enhancement and nonhomogeneous enhancement by contrast-enhanced ultrasound. Contrast-enhanced ultrasound can show the blood perfusion of hepatic capsule tuberculosis, which has important reference value in such diagnosis.