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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） ›› 2020, Vol. 17 ›› Issue (09) : 827 -833. doi: 10.3877/cma.j.issn.1672-6448.2020.09.003

所属专题： 文献；

腹部超声影像学

高帧频超声造影在肝富血供占位性病变动脉期中的成像优势与临床价值
费翔1, 罗渝昆1,†(), 李楠1, 韩鹏1, 唐文博2, 李杰3   
  1. 1. 100853　解放军总医院第一医学中心超声科
    2. 100853　解放军总医院第一医学中心肝胆外科
    3. 100853　解放军总医院第一医学中心病理科
  • 收稿日期:2020-07-28 出版日期:2020-09-01
  • 通信作者: 罗渝昆

Advantages and value of high-frame-rate contrast-enhanced ultrasound in arterial phase in evaluating focal liver lesions with hypervascularity

Xiang Fei1, Yukun Luo1,†(), Nan Li1, Peng Han1, Wenbo Tang2, Jie Li3   

  1. 1. Department of Ultrasound, the First Medical Centre of Chinese PLA General Hospital, Beijing 100053, China
    2. Department of Hepatobiliary Surgery, the First Medical Centre of Chinese PLA General Hospital, Beijing 100053, China
    3. Department of Pathology, the First Medical Centre of Chinese PLA General Hospital, Beijing 100053, China
  • Received:2020-07-28 Published:2020-09-01
  • Corresponding author: Yukun Luo
  • About author:
    Corresponding author: Luo Yukun, Email:
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引用本文：

费翔, 罗渝昆, 李楠, 韩鹏, 唐文博, 李杰. 高帧频超声造影在肝富血供占位性病变动脉期中的成像优势与临床价值[J]. 中华医学超声杂志（电子版）, 2020, 17(09): 827-833.

Xiang Fei, Yukun Luo, Nan Li, Peng Han, Wenbo Tang, Jie Li. Advantages and value of high-frame-rate contrast-enhanced ultrasound in arterial phase in evaluating focal liver lesions with hypervascularity[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(09): 827-833.

目的

探讨高帧频超声造影（H-CEUS）在肝富血供结节动脉期成像的优势及其潜在的临床价值。

方法

选取2018年5月至2019年12月在解放军总医院第一医学中心因肝局灶性病变而行超声造影（CEUS）检查患者88例。根据病理及增强磁共振结果分为恶性组和良性组。研究对象分别行超声、CEUS和H-CEUS检查并记录动态图像。2位医师分别对超声、CEUS和H-CEUS图像进行独立分析并记录结果，统计分析CEUS和H-CEUS图像特征。采用t检验比较良性组和恶性组患者年龄和结节最大径的差异，采用χ2检验比较良性组和恶性组患者性别、结节数量和结节血流的差异、2种超声造影模式特征（开始增强时间、增强程度、均匀性、方向和血管形态）的差异以及2种造影模式下不同大小恶性结节血管形态的差异。

结果

良性组与恶性组间患者年龄（t=3.428，P=0.001）、结节最大径（t=3.039，P=0.003）及结节血流比较（χ2=8.159，P=0.004）差异均有统计学意义。开始增强时间、增强程度与均匀性在CEUS和H-CEUS技术间比较，差异均无统计学意义（P均>0.05）。造影增强方向及血管形态在2种造影技术间比较，差异均有统计学意义（χ2=54.795、11.510，P均<0.05）。结节最大径≤3.0 cm的恶性组中2种造影技术在显示血管形态方面，差异有统计学意义（χ2=12.983，P<0.001），结节最大径>3.0 cm的恶性组中2种造影技术在显示血管形态方面，差异无统计学意义（P>0.05）。

结论

通过提高超声图像帧频有助于准确地显示动脉期的增强特征和血管形态，尤其是对于最大直径≤3.0 cm的富血供结节H-CEUS可以弥补CEUS在这方面的局限性。

关键词: 超声造影, 局灶性肝结节, 肝肿瘤
Objective

To explore the advantages of high-frame-rate contrast-enhanced ultrasound (H-CUES) in the arterial phase in evaluating hypervascular focal liver lesions (FLL) by comparing with conventional contrast-enhanced ultrasound (CUES) and to clarify the potential clinical value of this technique.

Methods

A total of 88 patients with focal liver lesion (FLL) were enrolled in this study at the First Medical Centre of Chinese PLA Genral Hospital from May 2018 to December 2019. The patients were divided into either a malignant lesion group or a benign lesion group. All malignant lesions were proved by pathological findings and all benign lesions were proved by contrast-enhance magnetic resonance imaging. Gray-scale ultrasound (US), CUES, and H-CEUS were performed in each patient. US, CUES, and H-CEUS images were interpreted independently by two doctors and images features were statistically analyzed between CUES and H-CEUS. The t test was used to compare the difference of age and nodule maximum diameter between benign and malignant groups, and χ2 test was used to compare the differences of sex, nodule number and nodule blood flow between benign and malignant groups, the characteristics of two contrast-enhanced models (start enhancement time, enhancement degree, uniformity, direction and vascular morphology), and the differences of vascular morphology of malignant nodules of different sizes under contrast-enhanced models.

Results

There were significant differences in patient age (t=3.428, P=0.001), maximum diameter of FLL (t=3.039, P=0.003), and blood flow within FLL by CDFI (χ2=8.159, P=0.004) between the two groups. Start time, intensity, and homogeneity of enhancement did not differ significantly between CEUS and H-CEUS (P>0.05). Fill-in direction (χ2=54.795, P<0.05) and vascular morphology (χ2=11.510, P<0.05) differed significantly between CEUS and H-CEUS. In malignant FLL with maximum diameter<3.0 cm, there was a significant difference in vascular morphology between CUES and H-CEUS (χ2=12.983, P=0.001), but in malignant FLL with maximum diameter>3.0 cm, there was no significant difference (P>0.05).

Conclusion

By increasing the frame rate of CEUS, H-CEUS could dynamically and accurately display fill-in patterns and vascular morphology in the arterial phase, especially in FLL with maximum diameter<3.0 cm. H-CEUS can compensate for the limitations of CEUS in this respect.

Key words: Contrast-enhanced ultrasound, Focal liver lesion, Liver tumor
表1 肝局灶性病变良性组与恶性组患者一般临床资料及超声特征比较
组别 例数 年龄（岁，±s） 男/女（例） 结节最大径（cm，±s） 回声特征（例） 结节数量（单发/多发，例） 结节血流（存在/不存在，例）
高回声 等回声 低回声
良性组 30 48.98±10.56 21/9 2.87±1.48 9 3 18 24/6 17/13
恶性组 58 59.85±11.88 45/13 3.69±1.77 18 6 34 41/17 49/9
统计值 ? t=3.428 χ2=0.607 t=3.039 χ2=0.016 χ2=0.888 χ2=8.159
P值 ? 0.001 0.436 0.003 0.992 0.346 0.004
表2 58例恶性结节常规超声造影与高帧频超声造影特征比较（例）
造影模式 开始增强时间 增强程度 增强均匀性 增强方向 血管形态
早期 非早期 高增强 非高增强 均匀 非均匀 向心型 离心型 整体同步 不规则 轮辐样 结节样 不确定型
超声造影 50 8 47 11 31 27 15 0 43 35 0 0 23
高帧频超声造影 51 7 49 9 34 24 52 2 4 51 0 0 7
χ2值 0.077 0.242 0.315 54.795 11.51
P值 0.782 0.623 0.575 <0.001 0.001
表3 30例良性结节常规超声造影与高帧频超声造影特征比较（例）
造影模式 开始增强时间 增强程度 增强均匀性 增强方向 血管形态
早期 非早期 高增强 非高增强 均匀 非均匀 向心型 离心型 整体同步 不规则 轮辐样 结节样 不确定型
超声造影 21 9 27 3 26 4 17 3 10 0 3 17 10
高帧频超声造影 21 9 27 3 25 5 17 11 2 0 11 17 2
χ2值 0.000 0.000 0.131 9.905 9.905
P值 1.000 1.000 0.718 0.007 0.007
图1 肝局灶性结节性增生结节超声造影与高帧频超声造影。图a为肝右叶等回声结节，最大径1.3 cm；图b为彩色多普勒超声显示结节内存在血流信号；图c为超声造影动脉早期结节开始增强，增强区首先出现在结节内部（箭头）；图d~g为增强区自结节内部向周边部依次出现，呈离心型增强；图h为高帧频造影显示动脉早期增强区首先出现在结节内部（细箭头），并可见滋养血管（粗箭头）；图i~m为高帧频造影显示动脉期增强区自结节内部向周边部依次出现，呈离心型增强并可见轮辐样血管结构
表4 58例不同大小恶性结节超声造影与高帧频超声造影显示结节血管形态的比较
造影模式 1.0~3.0 cm（31例） >3.0~5.0 cm（18例） >5.0 cm（9例）
不规则型 不确定型 不规则型 不确定型 不规则型 不确定型
超声造影 11 20 15 3 9 0
高帧频超声造影 25 6 17 1 9 0
χ2值 12.983 1.125 0.000
P值 <0.001 0.289 1.000
图2 肝细胞癌超声造影与高帧频超声造影。图a为肝右叶等回声结节；图b为彩色多普勒超声显示结节内存在血流信号；图c为超声造影动脉早期增强区首先出现在结节周边部（箭头）；图d~f为超声造影动脉期结节成向心型增强；图g~l为高帧频造影显示动脉期增强区自结节周边部（箭头）向内部依次出现，呈向心型增强并可见不规则血管结构
图3 肝细胞癌超声造影与高帧频超声造影。图a为灰阶超声显示肝右前叶下段胆囊旁高回声结节（结节最大径1.8 cm）；图b为彩色多普勒超声显示结节周边部存在血流信号；图c为超声造影动脉早期显示结节早于周围肝开始增强，呈整体增强表现；图d为超声造影动脉晚期显示结节呈高增强；图e为高帧频造影动脉早期显示结节早于周围肝开始增强，周边部首先开始增强；图f~h为高帧频造影动脉期显示结节呈向心型高增强
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