切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2024, Vol. 21 ›› Issue (03) : 297 -303. doi: 10.3877/cma.j.issn.1672-6448.2024.03.008

腹部超声影像学

肝脏炎性假瘤的超声造影表现及其诊断价值
罗敏华1, 王文平2, 孔文韬1,†()   
  1. 1. 210009　南京，南京大学医学院附属鼓楼医院超声科
    2. 200032　上海，复旦大学附属中山医院超声科
  • 收稿日期:2023-03-29 出版日期:2024-03-01
  • 通信作者: 孔文韬
  • 基金资助:
    “十三五”南京市卫生青年人才培养工程资助项目(QRX17011)

Contrast-enhanced ultrasound findings of hepatic inflammatory pseudotumors and their diagnostic value

Minhua Luo1, Wenping Wang2, Wentao Kong1,†()   

  1. 1. Department of Ultrasound, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210009, China
    2. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Received:2023-03-29 Published:2024-03-01
  • Corresponding author: Wentao Kong
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

罗敏华, 王文平, 孔文韬. 肝脏炎性假瘤的超声造影表现及其诊断价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(03): 297-303.

Minhua Luo, Wenping Wang, Wentao Kong. Contrast-enhanced ultrasound findings of hepatic inflammatory pseudotumors and their diagnostic value[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(03): 297-303.

目的

分析肝脏炎性假瘤的超声造影表现，并探讨超声造影对炎性假瘤的诊断价值。

方法

回顾性分析南京鼓楼医院和复旦大学附属中山医院自2012年12月至2022年12月76例经病理证实的肝脏炎性假瘤患者的临床及超声造影资料，总结其常规超声及超声造影的特点并评价其诊断准确率。

结果

76例肝脏占位超声造影动脉期可见5种增强模式：整体均匀增强（27.63%，21/76）、整体不均匀增强（26.32%，20/76）、周边环状增强（26.32%，20/76）、蜂窝状增强（14.47%，11/76）和三期无增强（5.26%，4/76）。强化程度为45例高增强，22例等增强，5例低增强，4例无增强。病灶在超声造影门脉期及延迟期呈低回声、混合回声、等回声和无回声的分别有55例、15例、2例、4例。所有病例的开始增强时间、达峰时间和廓清时间分别为15.0（13.0，19.3）s、22.0（19.8，26.3）s、35.0（30.0，50.0）s。有56例（73.68%）在注射造影剂后60 s内出现廓清，呈现“快进快退”模式，其中45例病灶在45 s内廓清。根据超声结果、临床表现及实验室检查，48例（63.16%）病灶被正确诊断为炎性假瘤，而其余28例被误诊为恶性肿瘤（30.26%，23/76）或诊断不确定（6.58%，5/76）。

结论

肝脏炎性假瘤在疾病进展过程中因病理不同而表现出多种强化模式，超声造影特征对其诊断具有一定的价值，同时需结合临床表现与实验室检查有助于提高诊断准确率。

关键词: 超声造影, 肝脏, 炎性假瘤, 增强模式, 鉴别诊断
Objective

To analyze the contrast-enhanced ultrasound (CEUS) findings of hepatic inflammatory pseudotumors (IPTs), and to assess their diagnostic value.

Methods

From December 2012 to December 2022, the clinical and contrast-enhanced ultrasound data of 76 patients with pathologically confirmed hepatic IPTs at Nanjing Drum Tower Hospital and Shanghai Zhongshan Hospital were retrospectively analyzed. The characteristics of conventional ultrasound (US) and contrast-enhanced ultrasound were summarized and their diagnostic accuracy was evaluated.

Results

Five enhancement patterns were observed in 76 liver nodules: homogeneous enhancement (n=21, 27.63%), heterogeneous enhancement (n=20, 26.32%), rim-like enhancement (n=20, 26.32%), honeycomb enhancement (n=11, 14.47%), and no enhancement during vascular phases (n=4, 5.26%). The degree of enhancement was hyper-enhancement in 45 cases, iso-enhancement in 22, hypo-enhancement in 5, and no enhancement in 4. The number of nodules that were hypoechoic, mixed, isoechoic, and anechoic in the portal and delayed phases was 55, 15, 2, and 4, respectively. The median initial enhancement time, time to peak, and wash-out time were 15.0 (13.0, 19.3) s, 22.0 (19.8, 26.3) s, and 35.0 (30.0, 50.0) s, respectively. Fifty-six nodules (73.68%) were hypoechoic within 60 s after contrast medium injection, showing a "quick wash-in and wash-out" pattern, and 45 nodules were hypoechoic within 45 s. Based on ultrasonography, clinical findings, and laboratory examination, 48 nodules (63.16%) were correctly diagnosed as IPTs, while the remaining 28 cases were misdiagnosed as malignancy (n=23, 30.26%) or had an uncertain diagnosis (n=5, 6.58%).

Conclusion

Hepatic IPTs show various enhancement patterns due to pathological changes during the progression of the disease. The features of CEUS have appreciated value in the diagnosis of IPT, and the combination of clinical manifestations and laboratory examination helps to improve the diagnosis coincidence rate.

Key words: Contrast-enhanced ultrasound, Liver, Inflammatory pseudotumor, Enhancement pattern, Differential diagnosis
图1 患者女性，34岁，发热10余天，超声发现肝占位。图a、b：二维超声示肝内多发低回声灶，边缘欠清，彩色多普勒超声示病灶周边可见条状血流信号。图c：超声造影示病灶动脉期呈整体均匀性增强，呈现快进快退造影特征。图d：增强MRI示病灶周边呈环形强化，图e：病理图（HE×200）示肝细胞灶状坏死伴嗜酸性粒细胞浸润，慢性炎症和肉芽肿形成
图2 患者女性，64岁，发热伴呕吐5 d，病理诊断慢性炎症细胞浸润及坏死。图a：二维超声示肝右叶不均质等回声病灶，边缘不清晰。图b：超声造影示病灶动脉期呈蜂窝状增强，内见散在不增强，在超声造影引导下穿刺活检。图c：增强CT示病灶呈不均匀强化，内见散在低密度无强化区。图d~f：磁共振平扫示肝内长T1长T2信号肿块，内见散在小囊状长T1长T2信号，弥散加权成像示肿块内小囊状影明显弥散受限
表1 2组肝脏炎性假瘤的二维超声和超声造影特征比较
超声特征 病灶≤3 cm组（31例） 病灶>3 cm组（45例） 统计值 P值
病灶回声（例） χ2=5.436 0.776
高回声 4 4
低回声 26 34
等回声 1 0
混合回声 0 7
边界（例） χ2=2.999 0.631
清晰 15 13
不清晰 16 32
内部回声（例） χ2=11.554 0.224
均匀 13 4
不均匀 18 41
动脉期增强模式（例） χ2=9.424 0.276
均匀增强 9 12
不均匀增强 5 15
环状增强 12 8
蜂窝状增强 2 9
无增强 3 1
强化后边界（例） χ2=0.440 0.197
清晰 5 10
不清晰 26 35
内部坏死（内部无增强区）（例） χ2=2.322 0.382
有 16 31
无 15 14
病灶的增强时间[s，M（QR）]
开始增强时间 18.0（13.3，20.0） 14.0（12.3，17.8） W=768.5 0.078
达峰时间 22.5（19.3，27.0） 22.0（19.3，26.0） W=623.0 0.940
开始廓清时间 35.0（28.5，50.0） 36.0（30.0，55.5） W=494.5 0.625
强化程度（例） χ2=3.853 0.053
高 20 25
等 6 16
低 2 3
无 3 1
门脉期延迟期呈低回声（例） χ2=8.955 0.276
是 22 33
否 9 12
快进快退（例） χ2=0.505 0.342
是 22 34
否 9 11
诊断结果（例） χ2=0.099 0.066
炎性假瘤 19 29
恶性肿瘤 10 13
不确定 2 3
1
Wu CH, Chiu NC, Yeh YC, et al. Uncommon liver tumors: Case report and literature review [J]. Medicine (Baltimore), 2016, 95(39): 49-52.
2
Chang SD, Scali EP, Abrahams Z, et al. Inflammatory pseudotumor of the liver: a rare case of recurrence following surgical resection [J]. J Radiol Case Rep, 2014, 8(3): 23-30.
3
Zhao J, Olino K, Low LE, et al. Hepatic inflammatory pseudotumor: an important differential diagnosis in patients with a history of previous biliary procedures [J]. ACG Case Rep J, 2019, 6(1): 00015.
4
Claudon M, Dietrich CF, Choi BI, et al. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS [J]. Ultrasound Med Biol, 2013, 39(2): 187-210.
5
Kono Y, Lyshchik A, Cosgrove D, et al. Contrast Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS®): the official version by the American College of Radiology (ACR) [J]. Ultraschall Med, 2017, 38(1): 85-86.
6
董彩虹, 王文平, 毛枫, 等. 肝炎性假瘤超声造影诊断研究 [J]. 中华超声影像学杂志, 2017, 26(1): 48-52.
7
Han MS, Moon KS, Lee KH, et al. Intracranial Inflammatory pseudotumor associated with idiopathic hypertrophic pachymeningitis mimicking malignant tumor or high-grade meningioma [J]. World Neurosurg, 2020, 134(5): 372-376.
8
Sheng RF, Zhai CW, Ji Y, et al. Role of MR in the differentiation of IgG4-related from non-IgG4-related hepatic inflammatory pseudotumor [J]. Hepatobiliary Pancreat Dis Int, 2017, 16(6): 631-637.
9
Murphy-Lavallee J, Jang HJ, Kim TK, et al. Are metastases really hypo vascular in the arterial phase the perspective based on contrast-enhanced ultrasonography [J]. Ultrasound Med, 2007, 26(11): 1545-1556.
10
Kong WT, Wang WP, Shen HY, et al. Hepatic inflammatory pseudotumor mimicking malignancy: the value of differential diagnosis on contrast enhanced ultrasound [J]. Med Ultrasound, 2021, 23(1): 15-21.
11
Zhang X, Tang S, Huang L, et al. Contrast-enhanced sonographic characteristics of hepatic inflammatory pseudo tumors [J]. J Ultrasound Med, 2016, 35(9): 2039-2047.
12
Feng Y, Qin XC, Luo Y, et al. Efficacy of contrast-enhanced ultrasound washout rate in predicting hepatocellular carcinoma differentiation [J]. Ultrasound Med Biol, 2015, 41(6): 1553-1560.
13
Xu HX, Chen LD, Liu LN, et al. Contrast-enhanced ultrasound of intrahepatic cholangiocarcinoma: correlation with pathological examination [J]. Br J Radil, 2012, 85(1016): 1029-1037.
14
薛海燕, 孔文韬, 沈海云, 等. 超声造影在肝内胆管癌与肝脏炎性假瘤鉴别诊断中的应用 [J]. 肿瘤影像学, 2020, 29(5): 483-488.
15
张晓东, 雷小莹, 方苇, 等. 超声造影在肝脏局灶性病变诊断中的价值[J/CD]. 中华医学超声杂志(电子版), 2006, 3(3):189-190.
16
Bhayana D, Kim TK, Jang HJ, et al. Hypervascular liver masses on contrast-enhanced ultrasound: the importance of washout [J]. AJR 2010, 194(4): 977-983.
17
Motojuku M, Oida Y, Morikawa G, et al. Inflammatory pseudotumor of the liver: case report and review of literature [J]. Tokai J Exp Clin Med, 2008, 33(2): 70-74.
[1] 王亚红, 蔡胜, 葛志通, 杨筱, 李建初. 颅骨骨膜窦的超声表现一例[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(11): 1089-1091.
[2] 汪洪斌, 张红霞, 何文, 杜丽娟, 程令刚, 张雨康, 张萌. 低级别阑尾黏液性肿瘤与阑尾黏液腺癌超声及超声造影特征分析[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(09): 865-871.
[3] 宋勇, 李东炫, 王翔, 李锐. 基于数据挖掘法分析3 种超声造影剂不良反应信号[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(09): 890-898.
[4] 王博冉, 乔春梅, 李春歌, 王欣, 王晓磊. 超声造影评估类风湿关节炎亚临床滑膜炎疾病进展的价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(08): 802-808.
[5] 马晓菊, 梁潇, 段云友, 袁丽君, 赵萍. NBAV脂质纳泡对ApoE -/-小鼠动脉粥样硬化病变的评估和干预[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(06): 608-616.
[6] 叶美妮, 刘思嘉, 臧玉玮, 刘云建. 肝硬化门静脉血栓形成的研究进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 379-384.
[7] 刘连新, 张树庚. 腹腔镜左半肝联合左尾状叶切除术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 368-368.
[8] 任江波, 李丽, 王萍. 阻断PI3K/Akt信号通路促进低表达FoxA2肝脏前体细胞对分化诱导剂应答并朝肝细胞方向分化[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(06): 336-343.
[9] 蔡艺丹, 方坚, 张志强, 陈莉, 张世安, 夏磊, 阮梅, 李东良. 经颈静脉肝内门体分流术对肝硬化门脉高压患者肠道菌群及肝功能的影响[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 285-293.
[10] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[11] 雷永琪, 刘新阳, 杨黎渝, 铁学宏, 俞星新, 耿志达, 刘雨, 陈政良, 惠鹏, 梁英健. 肝脏血管周上皮样细胞肿瘤合并贫血一例并文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 710-718.
[12] 张红君, 郑博文, 廖梅, 任杰. 超声及超声造影在肝移植术后上腹部淋巴结良恶性鉴别诊断中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 562-567.
[13] 陈慧, 邹祖鹏, 周田田, 张艺丹, 张海萍. 皮肤镜对头皮红斑性皮肤病辅助鉴别诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 692-698.
[14] 温绍敏, 王雅晳, 施依璐, 段莎莎, 云书荣, 张小杉. 靶向超声造影技术在动脉粥样硬化治疗中的应用进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 496-499.
[15] 史宛瑞, 崔立刚. 颈动脉一过性血管周围炎综合征的影像学诊断研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 516-519.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号