探讨超声造影（CEUS）引导下穿刺活检在肝占位性病变中的应用价值。

收集2016年9月至2017年11月浙江大学医学院附属第一医院拟接受超声引导下经皮肝占位性病变穿刺活检术的患者42例。所有患者穿刺活检前均进行CEUS，在CEUS引导下对肝占位性病变靶向定点经皮肝穿刺活检。以穿刺活检获取组织材料送病理学诊断达到要求为取材满意。活检病理诊断结果为恶性或手术病理结果确诊。未见恶性肿瘤时，结合电子计算机断层扫描（CT）、磁共振成像（MRI）、CEUS、正电子发射计算机断层显像（PET）、发射型计算机断层扫描（ECT）、血管造影、肿瘤标志物［甲胎蛋白（AFP）、糖类抗原199（CA199）等］等检查，随访超过3个月无变化者，考虑为良性病变。

本组42例肝占位性病变患者最终临床诊断结果为：肝细胞癌19例，胆管细胞癌3例，转移性肝癌9例，结节性肝硬化3例，炎症5例，海绵状血管瘤1例，局灶性结节增生1例，不典型增生结节1例。在CEUS引导下，选择增强强度和方式为恶性的增强活性区进行了穿刺活检取材，穿刺次数1~2次，平均穿刺（1.74±0.21）次。本组42例肝占位性病变患者穿刺活检病理结果为：肝细胞癌19例，胆管细胞癌3例，转移性肝癌9例，结节性肝硬化3例，炎症5例，海绵状血管瘤1例，局灶性结节增生1例，不典型增生结节1例。CEUS引导下穿刺活检取材成功率100%（42/42），穿刺阳性率100%（42/42），穿刺活检诊断符合率100%（42/42）。所有患者穿刺活检后均无肝周肠间隙或腹盆腔出血、气胸、针道种植、胆漏、大血管损伤等并发症发生。

CEUS可敏感显示肝占位性病变内微血供情况，准确判断病灶的活性区与坏死液化区域，确认常规超声分辨不清的微小占位，可提高穿刺活检取材成功率、穿刺阳性率、穿刺活检定性诊断符合率以及恶性病变确诊率。

To study the application value of biopsy under the guidance of contrast-enhanced ultrasound (CEUS) in hepatic space-occupying lesions.

Totally 42 patients who were planned to receive ultrasound guided percutaneous biopsy for liver space-occupying lesion in First Affiliated Hospital, Zhejiang University School of Medicine from September 2016 to November 2017 were included in this study. All patients underwent CEUS before biopsy, and the targeted percutaneous biopsy for liver occupying lesions was conducted under the guidance of CEUS. The biopsy tissues were satisfied if enough for the pathology diagnosis. The pathological diagnosis of malignancy was based on the biopsy findings or surgical results. If no malignancy was found in pathology, the lesions were clinically considered to be benign based on the findings of imaging examinations [computer tomography (CT), magnetic resonance imaging (MRI), CEUS, positron emission tomography (PET), emission computed tomography (ECT), and angiography], tumor markers [alpha fetal protein (AFP), carbohydrate antigen 199 (CA199), etc.], and no change in follow-up more than 3 months.

Under the guidance of CEUS, the areas with malignant enhancement pattern were selected for biopsy. The puncture times were 1 to 2 with an average of (1.74±0.21) times. The biopsy pathology diagnosis of 42 patients with liver space-occupying lesions in the study was: hepatocellular carcinoma 19 cases, cholangiocarcinoma 3 cases, metastatic liver cancer 9 cases, liver nodular cirrhosis 3 cases, inflammation 5 cases, cavernous hemangioma 1 case, focal nodular hyperplasia 1 case, and atypical hyperplasia nodules 1 case. The puncture success rate of CEUS guided biopsy was 100% (42/42), the positive puncture rate 100% (42/42), and the diagnosis coincidence rate 100% (42/42). All patients in this study had no complications such as perihepatoenteric space or pelvic bleeding, pneumothorax, needle implantation, bile leakage, or major vascular injury after biopsy.

CEUS can show microvascular bood-supply of liver space-occupying lesions, accurately determine the active areas and necrosis/liquefied areas, confirm the tiny lesions that conventional ultrasound cannot detect, and thus can improve puncture success rates, the positive puncture rates, the diagnosis coincidence rates and malignant lesion pathological diagnosis rates.