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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2018, Vol. 15 ›› Issue (02) : 81 -89. doi: 10.3877/cma.j.issn.1672-6448.2018.02.001

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儿童肝脏局灶性病变的经静脉造影增强超声
毛木翼1, 夏焙1,†()   
  1. 1. 518026　汕头大学医学院附属深圳市儿童医院超声影像科
  • 收稿日期:2017-12-01 出版日期:2018-02-01
  • 通信作者: 夏焙

Contrast-enhanced ultrasound of focal liver lesions in children

Muyi Mao1, Bei Xia1()   

  • Received:2017-12-01 Published:2018-02-01
  • Corresponding author: Bei Xia
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毛木翼, 夏焙. 儿童肝脏局灶性病变的经静脉造影增强超声[J]. 中华医学超声杂志（电子版）, 2018, 15(02): 81-89.

Muyi Mao, Bei Xia. Contrast-enhanced ultrasound of focal liver lesions in children[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(02): 81-89.

图1 儿童肝脏局灶性病变造影增强超声模式图。造影增强超声图像分为动脉相、门脉相和晚期静脉相；图中白圈内橙色标示的肝脏局灶性病变呈高增强，其增强程度高于肝实质；白圈内黑色标示的病变区无增强，提示病变区有出血或坏死；病变区低增强表示增强程度低于肝实质；灰线为中央瘢痕
图2~7 患儿女性，39 d，肝右叶快速消退型先天性血管瘤超声声像图及MRI影像图。图2灰阶声像图示肝右叶中央钙化的局灶型肿块（箭头所示）；图3彩色多普勒血流成像示肿块内血流信号；图4~7为超声造影动脉相。图4（门脉相）、5（静脉相）、6中箭头示肿块由周边向中央逐渐增强；图7为MRI增强动脉相，与超声造影图像表现类似，肿块呈边缘强化（箭头所示）
图8~10 患儿男性，4岁，肝右叶局灶性结节性增生灰阶超声及造影增强超声图像。图8灰阶声像图示肝右叶内低回声局灶性肿块（箭头所示）；图9为超声造影动脉相，肿块（箭头所示）呈中心轮辐状增强；图10为超声造影静脉相，肿块（箭头所示）中央瘢痕的后期增强
图11~14 患儿女性，14岁，肝左叶局灶性脂肪瘤灰阶超声及造影增强超声图像。图11灰阶声像图示肝左叶局灶性回声肿块（箭头所示）；图12~14为造影增强超声（左）与灰阶超声（右）双幅对比图像，显示肿块（箭头所示）在动脉相（图12）、门脉相（图13）、静脉相（图14）与周围肝实质呈等增强
图15~18 患儿男性，12岁，肝硬化伴再生结节造影增强超声图像及增强MRI影像图。图15~17为造影增强超声（左）与灰阶超声（右）双屏对比图像，显示结节（箭头所示）在动脉相（图15）、门脉相（图16）和静脉相（图17）与邻近肝实质相似，未见早期动脉相廓清；图18增强MRI显示肝Ⅱ段有一个增强结节（白圈标示）
图19~22 患儿女性，6个月，肝母细胞瘤MRI及超声影像图。图19为T2加权MRI示肝内肿块（箭头所示）呈高信号；图20灰阶声像图示肝内肿块（箭头所示）回声不均匀；图21，22为造影增强超声图像（左）和灰阶声像图（右）示肿块（箭头所示）在动脉相（图21）周围性增强和静脉相（图22）的造影剂廓清
图23~26 患儿男性，29 d，肝母细胞瘤超声声像图、CT影像图、手术标本及病理镜检图。图23灰阶声像图示肝内巨大非均匀肿块，多发囊性区（长箭头所示）和实质区（短箭头所示）；图24冠状位增强CT重建的动脉相，清晰显示分隔的多个囊性成分（长箭头所示）和实性成分（短箭头所示），以周围性增强为主（黑箭头所示）；图25手术大体标本切面示肝肿瘤囊状变性和中央坏死灶；暗绿色为肿瘤内胆汁淤滞灶；图26病理镜检示肝肿瘤为混合上皮和间质的肝母细胞瘤（HE ×100）
图27~34 患儿男性，5岁9个月，肝细胞肝癌超声及CT影像图。图27灰阶声像图示肝右叶不规则肿块，回声不均（箭头所示）；图28彩色多普勒血流成像示肿块内血流信号；图29~31灰阶声像图（左）与造影增强超声（右）双屏对比图示动脉相（图29）肿块（箭头所示）快速弥散性增强和门脉相（图30）快速廓清，静脉相（图31）低于相邻的正常肝脏；图32~34增强CT示动脉相（图32）明显强化，呈"快进快出"，静脉相（图34）强化程度弱于相邻的正常肝脏
图35~37 患儿女性，7岁，游戏时摔倒，导致肝裂伤。图35，36灰阶声像图显示肝脏矢状面（图35）和横断面（图36，箭头所示）增强区域和包膜下血肿（*标示），未显示裂伤；图37矢状位造影增强超声图。箭头示造影无增强区，符合3级肝裂伤
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