探讨高帧频超声造影（H-CEUS）在慢性肝病患者≤3 cm肝局灶性病变（FLL）定性诊断方面的临床应用价值。

选取2018年1月至2023年4月至瑞金医院及瑞金无锡分院超声科进行肝常规超声造影（CEUS）和H-CEUS检查的153例慢性肝病患者（共176个病灶，病灶最大径均≤3 cm）的CEUS资料进行回顾性分析。所有入组病灶最终由穿刺活检、手术病理、CT增强或MRI增强等其他影像学诊断经随访证实，并将入组病例分为良性组和恶性组。所有入组病例均进行常规CEUS、H-CEUS检查并分别记录静态和动态图像。由2位医师分别对以上检查进行独立分析并记录结果，采用χ²检验比较良、恶性组内这2种CEUS模式特征（开始增强时间、增强程度、增强均匀性、增强方向和血管构型）的差异。采用χ²检验统计分析常规CEUS与H-CEUS在慢肝患者≤3 cm FLL定性诊断的诊断效能，并计算相应的诊断敏感度、特异度、准确性等。

良、恶性组内开始增强时间、增强程度、增强均匀性在常规CEUS与H-CEUS 2种造影技术间比较，差异均无统计学意义（P均>0.05），恶性组内2种造影模式在血管构型和增强方向方面比较，差异均有统计学意义（χ²=6.480、58.284，P=0.011、<0.001）。H-CEUS较常规CEUS可提高慢性肝病FLL诊断的敏感度（93.68% vs 80.00%）和准确性（92.61% vs 83.52%），两者差异具有统计学意义（χ²=7.784、6.921，P=0.005、0.009），但两者之间特异度差异无统计学意义（P>0.05）。

H-CEUS通过提高实时帧频，可提供FLL在动脉期增强方向和血管架构等方面的丰富诊断信息，有利于提高慢性肝病FLL良恶性鉴别诊断的能力。

The purpose of this study was to assess the value of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in the diagnosis of small (≤3 cm) focal liver lesions in patients with chronic liver disease.

From January 2018 to April 2023, 153 patients with chronic liver disease (176 lesions, ≤3 cm) who underwent CEUS and H-CEUS examinations at Ruijin Hospital and its Wuxi Branch were retrospectively analyzed. CEUS and H-CEUS images were interpreted independently by two doctors and image features were statistically analyzed between CEUS and H-CEUS. The χ² test was used to compare the differences in the characteristics of the two contrast-enhanced models (start enhancement time, enhancement degree, uniformity, fill-in direction, and vascular morphology) between the benign and malignant groups. The diagnostic performance of the two modalities was assessed by calculating sensitivity, specificity, accuracy, etc.

The start time, intensity, and homogeneity of enhancement did not differ significantly between CEUS and H-CEUS (P>0.05). Fill-in direction and vascular morphology differed significantly between CEUS and H-CEUS (χ²=6.480 and 58.284, P=0.011 and P<0.001, respectively) in the malignant group. H-CEUS had a higher sensitivity (93.68% vs 80.00%) and accuracy (92.61% vs 83.52%) than CEUS in the differential diagnosis of small focal liver lesions (χ²=7.784 and 6.921, P=0.005 and 0.009, respectively), but there was no statistical difference in specificity between the two modalities (P>0.05).

By increasing the frame rate of real-time images, H-CEUS can dynamically and accurately display fill-in patterns and vascular morphology in the arterial phase, thereby improving the differential diagnosis of small focal liver lesions.