肝结核球患者常规超声和超声造影表现:与细菌性肝脓肿患者对照的临床研究

目的 分析肝结核球患者常规超声和超声造影表现,并与细菌性肝脓肿患者相对照,探讨常规超声及超声造影对肝结核球的诊断价值.方法 对10例肝结核球患者(15个病灶)和16例细菌性肝脓肿患者(16个病灶)行常规超声检查后,对每个病灶行超声造影检查,分析每个病灶造影动态增强特点,同时定量分析时间-强度曲线,并记录造影剂开始增强时间及达峰时间.结果 15个肝结核球病灶常规超声均表现为低回声,超声造影动脉期增强均呈高增强,其中11个病灶呈环状增强,4个病灶呈弥漫性增强,造影剂开始增强时间为12.3～16.8 s,平均(14.1±1.9)s;达峰时间为23.5～32.3 s,平均(27.7±2.7)s.16个细菌性肝脓肿病灶中,10个常规超声表现为低回声,6个表现为不均质高低混合回声,超声造影动脉期增强均呈高增强,其中10个病灶为蜂窝状增强,4个病灶为周边环状增强,2个病灶为弥漫性增强,造影剂开始增强时间为13.3～21.3 s,平均(16.2±2.5)s;达峰时间为28.6～53.9 s,平均(35.6±8.6)s.所有病灶超声造影动脉期迅速增强至高峰后,增强逐渐消退持续至门脉期及延迟期,病灶呈现低回声或无回声.结论 肝结核球与肝脓肿常规超声及超声造影表现既有相似之处,也有其特征性表现,结合临床及病理改变可提高其诊断的准确性.

Ultrasonographic features of hepatic tuberculoma and bacterial hepatic abscess:a controlled study

Objective To observe the features of hepatic tuberculoma and compare with those of bacterial hepatic abscess on ultrasound.Methods Ten cases of hepatic tuberculoma (15 lesions) and 16 cases of bacterial hepatic abscess (16 lesions) were studied with conventional ultrasonography and contrast-enhanced ultrasonography (CEUS) to analyze dynamic enhancement of lesions,plot time-intensity curve for quantification,and collect data of the time to enhancement and the time to peak enhancement.Results Fifteen hepatic tuberculoma lesions were hypoechoic in conventional ultrasonography and hyperenhanced during the arterial phase in CEUS,of which eleven showed rim enhancement and four,diffuse enhancement.The time to enhancement for them was 12.3-16.8 s with an average of (14.1±1.9)s;the time to peak enhancement was 23.5-32.3 s with an average of (27.7±2.7) s.For 16 bacterial hepatic abscess lesions,10 were hypoechoic and 6 were heteroechoic in conventional ultrasonography.During the arterial phase,all 16 lesions were hyperenhanced,of which ten showed honeycomb like enhancement;four,rim enhancement,and two,diffuse enhancement.The time to enhancement for them was 13.3-21.3 s with an average of (16.2±2.5) s;the time to peak enhancement was 28.6-53.9 s with an average of (35.6±8.6) s.All lesions were rapidly enhanced to the peak during the arterial phase,and the enhancement was gradually attenuated until the portal venous phase and the delayed phase when they were hypoechoic or nonechoic.Conclusions Though hepatic tuberculoma and bacterial hepatic abscess are similar in conventional ultrasonography and CEUS,they are also characterized by typical features.Combination of clinical and pathological findings can improve the differential diagnosis of them.