肝局灶性结节性增生超声学诊断

目的：探讨肝局灶性结节性增生的声像图特征和鉴别诊断。方法：回顾性总结分析经手术和／或超声引导穿刺活检证实的8例肝局灶性结节性增生的二维及彩色多普勒声像图特征。结果：5例术前超声诊断为肝局灶性结节性增生,2例诊断为肝内良性病变,结合CT、MRI等检查而考虑本病,l例误诊为小肝癌。总符合率为87．5％(7／8)。结论：超声对肝局灶性结节性增生有较高的诊断价值,结合CT、MRI等检查有助于诊断,明确诊断有赖于超声引导下穿刺活检。     

超声造影与彩色多普勒超声对肝实质性肿块诊断价值

目的比较彩色多普勒超声和实时超声造影在肝实质性肿块中的诊断价值。方法应用彩色多普勒超声及超声造影技术对常规二维超声难以定性的29例患者共33个肝实质性肿块进行检查,结果与手术及病理结果相对照。结果33个肿块中原发性肝细胞性肝癌24个,肝血管瘤3个,肝脏局灶性结节增生3个,局限性脂肪肝2个,肝孤立性坏死结节1个。彩色多普勒超声在肿块内部或肿块周边能检测到动脉血流频谱者共19例21个肿块;超声造影除一例肝孤立性坏死结节外,其余32个病灶均在不同时相出现不同程度强化现象。如以动脉相呈高回声而门脉相及延迟相呈低回声为恶性肿块的诊断标准,则超声造影对肝癌诊断的准确性为92%;如以肿块内部检测到动脉样血流频谱为诊断恶性肿块的诊断标准,则彩色多普勒超声诊断肝癌的准确性为75%,二者差别有显著性(P<0.05)。结论实时超声造影显著提高肝实质性肿块诊断的准确性,对肝脏实质性肿块良、恶性的诊断及鉴别诊断具有重要价值。     

肝肿瘤实时灰阶谐波超声造影与动态增强螺旋CT对照研究

目的 探讨实时灰阶谐波超声造影和动态增强螺旋CT对肝局灶性病变的诊断价值.方法 选择肝局灶性病变患者49例,共54个病灶.其中包括原发性肝癌29个,转移性肝癌4个,肝血管瘤11个,肝局灶性结节增生7个,肝硬化结节1个,肝脂肪浸润不均2个.分别进行实时灰阶谐波超声造影和动态增强螺旋CT检查,比较肝肿瘤在两种成像方法中的表现.结果 两种成像方法显示的肝肿瘤在不同时相的表现及在动脉相的增强类型相一致.超声造影鉴别诊断肝良恶性病变的敏感性、特异性和准确性分别为 90.9%（30/33）、90.5%（19/21）和 90.7%（49/54）;动态增强螺旋CT鉴别诊断肝良恶性病变的敏感性、特异性、准确性分别为 90.9%（30/33）、95.2%（20/21）和 92.6%（50/54）,二者鉴别肝局灶性病变良恶性的能力差异无显著性意义.结论 实时灰阶谐波超声造影和动态增强螺旋CT均能反映肝病变的血流动力学特性,均有助于肝肿瘤的鉴别诊断.     

超声造影对肝脏肿瘤良恶性鉴别诊断的临床应用

目的探讨应用SonoVue进行超声造影对比常规超声在提高肝脏肿瘤良恶性鉴别诊断的应用价值。方法回顾分析78例常规超声检出肝脏局灶性病变（FLL）,根据二维及彩色多普勒特点,结合病史给出初步良恶性判断后,进一步采用超声造影,对病灶造影剂灌注过程进行分析,得出修正判断;最后以病理结果为金标准,进行统计学分析。结果78个病灶中病理结果示良性病灶32例,恶性病灶46例。超声造影在良恶性鉴别诊断的敏感性为92.8%,特异性为91.7%,准确性92.3%,明显优于常规超声。结论应用静脉团注SonoVue法进行实时灰阶超声造影有助于肝局灶性病变良恶性的鉴别诊断。     

超声造影对肝局灶性结节增生的诊断价值

目的:研究肝局灶性结节增生静脉声学造影的声像学特点,探讨超声造影对肝局灶性结节增生的诊断价值。方法:经增强CT或MR造影对照,并经手术及病理证实的肝局灶性结节增生病变9例,采用意大利Bracco公司生产的第二代超声造影剂Sonovue进行超声造影成像,造影时记录肝实质及病灶的充填过程、充盈方式及增强程度。结果:9例肝局灶性结节增生的造影表现为动脉相均为快速增强,其中6例为中央型,3例为整体型,门脉相本组病例均为高回声,延迟相8例为高回声,1例为等回声。结论:超声造影能清楚显示肝局灶性结节增生的造影充填过程及充填方式,对肝局灶性结节增生的诊断具有重要的意义。     

超声造影在脂肪肝背景下肝局灶性病变诊断中的应用价值

目的探讨超声造影在脂肪肝背景下肝局灶性病变的病灶检出和定性诊断等方面的应用价值。 方法对2018年1月至2020年7月在瑞金医院和瑞金无锡分院进行肝超声造影检查的108例轻中度脂肪肝患者（共153个病灶）的超声造影资料进行回顾性分析。部分病灶检查使用高帧频造影模式。所有的入组病灶最终由穿刺活检、手术病理证实、CT增强或MRI增强等其他影像学诊断经随访证实。比较常规超声与超声造影在病灶检出和定性诊断方面的应用价值,计算相应的诊断准确性、敏感度和特异度,采用χ²检验比较2种超声模式对于病灶良恶性诊断准确性的差异。 结果入组153个病灶中60个为良性,93个恶性,结果显示超声造影可以提高脂肪肝背景下肝局灶性病灶,尤其是微小转移瘤的检出率,其病灶检出率可由常规超声的78.43%（120/153）提高到98.69%（151/153）,而对于病灶的良恶性诊断准确性可由69.93%提高到94.12%,差异具有统计学意义（χ²=11.719,P=0.0016）,且敏感度和特异度均>91%,阳性预测值>94%。 结论超声造影可明显提高脂肪肝背景下肝局灶性病变特别是微小转移灶的检出率,大大提高肝局灶性病变的诊断准确性,为临床诊疗工作提供组织微循环灌注等重要诊断信息。     

肝脏局灶性结节状增生的超声表现

目的总结肝脏局灶性结节状增生的超声表现。方法62例肝脏局灶性结节增生患者共70个病灶接受了二维灰阶超声和彩色多普勒超声检查,总结病灶的灰阶超声、彩色多普勒超声特征。结果灰阶超声显示82.9%(5870)的病灶位于肝右叶,17.1%(1270)病灶位于肝左叶。74.3%(5270)的病灶为等或稍低回声,17.1%(1270)的病灶为低回声,8.6%(670)的病灶为高回声;92.9%(6570)的病灶彩色多普勒超声测得动脉血流信号。其中显示Ⅲ级、Ⅱ级及Ⅰ级血供的病灶分别为68.6%(4870)、18.6%(1370)、5.7%(470)。峰值流速14.4～113cms,其均值为46.5±24.2cms,阻力指数为0.4～0.7,其均值为0.55±0.07。结论肝脏局灶性结节状增生具有较特征性的超声表现,了解这些特点有助于诊断与鉴别诊断。     

彩色多普勒超声检查对经典型肝局灶结节增生的诊断价值

目的探讨彩色多普勒超声检查对经典型肝局灶结节增生的诊断价值。方法对43例48个经手术病理证实的肝局灶结节增生进行彩色多普勒超声检查,根据有无中心血流分为经典型与非经典型。将超声分型与病理分型进行对照研究。结果 48例肝局灶结节增生病理诊断为经典型36例,其中彩色多普勒超声检查检出中心血流27例。彩色多普勒超声检查对经典型肝局灶结节增生敏感度、特异度、阳性预测值、阴性预测值、诊断准确率分别为75.0%、91.7%、96.4%、55.0%、79.2%。结论彩色多普勒超声对经典型肝局灶结节增生诊断特异性较高,诊断可靠,敏感性略低,尚有部分病例超声检查不能显示中心血管,需进一步检查。     

彩色多普勒超声检查、超声造影、增强CT诊断肝脏局灶性结节样增生的比较

目的探讨肝脏局灶性结节样增生(FNH)的彩色多普勒超声检查、超声造影、增强CT表现及其诊断价值。方法 2006～2009年经手术及病理证实的10例FNH患者共14个病灶均行彩色多普勒超声检查,其中8个病灶行超声造影检查,4个病灶行增强CT检查。结果 14个病灶中,彩色多普勒超声检查显示5个病灶(5/14,35.71%)内有轮辐状血流信号,最大血流速度平均为(0.59±0.19)m/s,阻力指数平均为0.46±0.16。超声造影显示5个病灶(5/8,62.50%)出现动脉期早期迅速全瘤强化,其他3个病灶(3/8,37.50%)呈轮辐状离心性快速强化,门脉期及延迟期回声稍高于肝实质或与肝实质等回声,有2个病灶(2/8,25.00%)于延迟期见低回声中央星状瘢痕。增强CT显示4个病灶平扫均呈低密度,动脉期显著均匀性强化,门脉期强化接近于肝实质密度,有2个病灶(2/4,50.00%)于动脉期及门脉期见低密度星状瘢痕。结论彩色多普勒超声、超声造影、增强CT这3种方法结合可大大提高FNH的确诊率。     

超声造影在肝脏局灶性病变定性诊断中的价值

目的探讨超声造影在肝脏局灶性病变良恶性定性诊断中的价值。方法回顾性分析我院250例肝脏局灶性病变患者共258个病灶的常规超声和超声造影检查结果,比较两种检查方法对其良恶的定性诊断效能。结果 258个病灶中,常规超声准确诊断202个,其中良性54个,恶性148个;超声造影准确诊断242个,其中良性87个,恶性155个;超声造影对肝脏局灶性病变良恶性诊断的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为95.7%、90.6%、94.5%、92.6%、93.8%,与常规超声(91.4%、56.3%、77.9%、79.4%、78.3%)比较,除敏感性外,差异均有统计学意义(P0.05)。结论超声造影在肝脏局灶性病变的定性诊断中具有较高的应用价值。     

Paediatric focal nodular hyperplasia: A case study of typical contrast-enhanced ultrasound findings with quantitative analysis and correlated with magnetic resonance imaging

IntroductionFocal nodular hyperplasia, a benign liver tumour, is the second most common focal benign liver lesion, after a cavernous haemangioma. Contrast-enhanced ultrasound is used increasingly for the diagnostic work up and follow-up of focal liver lesions in adults, but is particularly valuable in the paediatric population, with the ability to reduce radiation and the nephrotoxic contrast agents used in computed tomography or magnetic resonance imaging. Confident recognition of focal nodular hyperplasia is important; it is benign, usually asymptomatic, of no clinical significance, of no clinical consequence or malignant potential. We present a case of focal nodular hyperplasia of the liver with its characteristic findings on conventional ultrasound, contrast-enhanced ultrasound with quantitative analysis and correlated with magnetic resonance imaging.Case presentation: A 15-year-old female with right upper quadrant abdominal pain was referred for liver ultrasound. A focal liver lesion was detected on B-mode ultrasound examination, and colour Doppler demonstrated no specific features. Contrast-enhanced ultrasound examination demonstrated early arterial enhancement, with a characteristic spoke-wheel pattern, centrifugal uniform filling of the lesion on the late arterial phase and sustained enhancement on the portal venous phase. Quantitative contrast-enhanced ultrasound has been performed, showing a typical curve of enhancement, as well as characteristic parametric images, supporting the interpretation of contrast-enhanced ultrasound and assisting the diagnosis. Magnetic resonance imaging demonstrated a central T2 hyperintense scar and similar enhancement characteristics as contrast-enhanced ultrasound on T1 gadolinium-enhanced sequences.ConclusionContrast-enhanced ultrasound is a useful technique for the differentiation of benign from malignant liver lesions and has the potential to establish the diagnosis of focal nodular hyperplasia, based on the enhancement pattern, which is similar to that observed on magnetic resonance imaging but can be better appreciated with superior temporal, contrast and spatial resolution of contrast-enhanced ultrasound.     

超声造影对肝局灶性结节增生的诊断价值

目的探讨超声造影对肝局灶性结节增生（FNH）的诊断价值。方法对17例FNH的灰阶超声、彩色多普勒超声、超声造影诊断情况进行分析比较。结果灰阶超声对FNH无特异的声像图改变；彩色多普勒超声诊断为FNH6例，符合率为35．3％（6／17）；超声造影检查11例，均探测到供血动脉及动脉早期轮辐状增强，诊断符合率为100％。结论超声造影可提高对FNH的诊断水平。     

Ultrasound of focal liver masses

Detecting and characterizing focal liver lesions is one of the most difficult challenges in imaging today. All standard noninvasive imaging modalities are less sensitive than generally perceived, and characterization is imperfect. Liver sonography's main strengths are its ability to definitively characterize common benign lesions (eg, cysts and hemangiomas), safety, low cost, and its ability to guide biopsy. Sonography's weaknesses include its inability to image the entire liver in many patients and its inferiority to CT as a means of detecting extrahepatic malignant disease. Sonography is less sensitive than CT or MRI in detecting focal lesions. Ultrasound contrast agents will certainly improve liver lesion detection and characterization, but their impact is not yet clear.Typical findings in common focal liver lesions are discussed, and some hints to improve sonographic diagnosis are presented. Increased color Doppler flow should bring the possibility of hepatocellular carcinoma and focal nodular hyperplasia to mind, but Doppler diagnosis is ultimately not highly specific. Sonography, including Doppler analysis, is useful to assess the resectability of malignant masses. Intraoperative ultrasound is the most sensitive imaging modality in detecting focal liver lesions.     

Primary Application of Micro-Flow Imaging Technology in the Diagnosis of Hepatic Tumors

The purpose of the study was to evaluate the vascular architecture of focal liver lesions with the newly released non-contrast micro-flow imaging (MFI) technique. Eighty patients with 80 hepatic tumors were enrolled in this study. The richness of displayed blood flow was first compared with color Doppler flow imaging using grades according to Adler's method. The results indicated that MFI outperformed color Doppler flow imaging with a statistically significant difference (p <0.0001). With the enhanced position in arterial phase of contrast-enhanced ultrasound imaging as the ground truth, the displayed blood flow distribution within tumors in MFI was further evaluated. The coincidence rate between MFI and contrast-enhanced ultrasound was 73.75% (59/80), which was higher than that of color Doppler flow imaging (52.5%, 42/80) (p < 0.0001). Moreover, for the five cases of focal nodular hyperplasia, MFI clearly revealed the spoke-wheel or radiating intra-tumoral vasculature, a finding specific to the diagnosis of focal nodular hyperplasia.     

彩色多普勒超声显像对肾上腺区占位性病变的定位及定性诊断价值

[目的]探讨彩色多普勒超声显像对肾上腺区占住性病变的定位及定性诊断价值。【方法】回顾性分析秦皇岛市第一医院2005年4月至2010年6月住院的123例肾上腺区占位性病变患者的彩色超声图像特征。[结果1123个病例中,超声定位诊断率为90．24％（111／123）,定性诊断率73．17％（90／123）。【结论】肾上腺区占位性病变的病理类型不同,其声像图表现亦各不相同,彩色多普勒超声是诊断肾上腺区占位性病变的主要方法和重要手段,对于病变的定位和定性诊断有一定价值。     

Hepatic Angiomyolipomas: Ultrasonic Characteristics of 25 Patients from a Single Center

Twenty-five pathologically proven hepatic angiomyolipomas (AMLs) were included in the study. Ultrasonic features of hepatic AMLs were reviewed. Three types of echogenicity were observed on ultrasound examination: (i) strong hyper-echogenicity, (ii) moderate hyper-echogenicity and (iii) hypo-echogenicity. Vascular signals within tumors could be detected in 22 (88.00%) tumors as multiple punctiform, filiform or dendriform signals by color Doppler flow imaging. Based on the enhancement patterns in the arterial, portal and late phases, the features of hepatic AMLs on contrast-enhanced ultrasound were divided into four subtypes: (i) “fast in slow out” (68.00%, n = 17); (ii) “fast in same out” (16%, n = 4); (iii) “fast in fast out” (12.00%, n = 3); and (iv) “fast in uneven out” (4.00%, n = 1). Contrast-enhanced ultrasound diagnosed 22 (88.00%) tumors as benign tumors and 13 (52.00%) as hepatic AMLs. Four cases were misdiagnosed as hepatic hemangioma, five cases as focal nodular hyperplasia (total = 36.00%). The rate of correct diagnosis of hepatic AMLs increased significantly from 24.00% for ultrasound alone to 52.00% for contrast-enhanced ultrasound. Therefore, information obtained from ultrasound, color Doppler flow imaging and contrast-enhanced ultrasound should be combined to improve diagnosis.     

彩色多普勒超声在脾结核诊断与分型中的临床价值

【目的】探讨彩色多普勒超声检查对脾结核诊断与分型的临床价值。【方法】选择经手术、穿刺活检病理证实或抗结核治疗治愈而确诊的29例脾结核,分析其彩色多普勒声像特征及临床分型。【结果129例患者中粟粒型8例,脾实质回声弥漫性增强,彩色多普勒示脾门及脾实质内血流丰富,血彩明亮;结节型11例,脾内单发或多发的弱回声结节,血流信号不丰富;脓肿型4例,脾实质内圆型低回声,内部无血流信号,周围脾实质内血管受压、推移,血流指数增高;钙化型6例,脾内散在分布多发点状或片状强回声钙化灶,血流未见明显异常。【结论】彩色多普勒超声检查能为脾结核的诊断与分型提供诊断依据。     

Contrast-enhanced ultrasonography using levovist: Usefulness of diagnosis of small focal nodular hyperplasia lesions

Differential diagnosis of focal nodular hyperplasia and hepatocellular carcinoma is clinically important because, while both are hypervascular tumors, they have vastly different prognoses. Because the spoke-wheel appearance is the primary characteristic of focal nodular hyperplasia, we attempted to detect this pattern in nodules smaller than 3 cm in diameter with contrast-enhanced ultrasonography using a contrast agent (Levovist). Four patients were examined with contrast-enhanced US: two of the patients were examined with Coded Harmonic Angio; the other two patients were examined with contrast-enhanced color and power Doppler US without harmonic imaging. Although the hepatic arteriogram showed the spoke-wheel appearance in only one tumor (diameter, 3 cm), contrast-enhanced US clearly demonstrated this characteristic in all four tumors, including three tumors that were less than 2 cm in diameter. Because it is noninvasive and can be carried out in an outpatient clinic, contrast-enhanced US is extremely useful for diagnosing small focal noduler hyperplasia lesions at sites that can be observed with US.