Tanaka S, Ioka T, Oshikawa O, Hamada Y, Yoshioka F
Department of Cancer Survey, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3, Nakamichi, Higashinari, Osaka, 537-8511 Japan.
AJR Am J Roentgenol. 2001 Oct;177(4):799-805. doi: 10.2214/ajr.177.4.1770799.
Our objectives were to propose and evaluate a dynamic sonography protocol for the characterization of hepatic tumors.
The subjects were 107 patients with focal liver lesions that initially had been found on conventional sonograms. The final diagnoses for the lesions were hepatocellular carcinoma in 60 patients, cholangiocellular carcinoma in six, metastatic carcinoma in 24, hemangioma in 10, and focal fat-spared region in seven. The pulse inversion harmonic imaging mode and a galactose-based contrast agent (Levovist) were used. Dynamic sonography was designed to obtain vascular-phase (composed of the arterial phase and the portal phase) images of the focal lesion and liver-parenchymal-phase images of the whole liver in a series obtained after a bolus injection of the contrast agent.
If the whole-tumor or mosaic enhancement patterns (arterial phase) and/or the reticular enhancement (parenchymal phase) are regarded as positive findings for hepatocellular carcinoma, the sensitivity, specificity, and positive predictive value of dynamic sonography in our study were 92%, 96%, and 96%, respectively. If a ring enhancement (arterial to portal phase) or a clear defect (parenchymal phase) or both are regarded as positive findings for cholangiocellular carcinoma or metastasis, the sensitivity, specificity, and positive predictive value were 90%, 95%, and 88%, respectively. If puddle enhancement (portal phase) is regarded as a positive finding for hemangioma, the figures for sensitivity, specificity, and positive predictive value were 60%, 100%, and 100%, respectively. Also, the tumors that showed no focal sign in the liver parenchymal phase were all benign lesions, such as hemangiomas or focal fat-spared regions.
Dynamic sonography in a protocol combining pulse inversion harmonic imaging and an IV bolus injection of the contrast agent proved to be an effective tool in characterizing liver tumors.
我们的目的是提出并评估一种用于肝脏肿瘤特征描述的动态超声检查方案。
研究对象为107例最初在常规超声检查中发现有肝脏局灶性病变的患者。病变的最终诊断结果为：肝细胞癌60例，胆管细胞癌6例，转移癌24例，血管瘤10例，局灶性脂肪 sparing 区域7例。采用脉冲反转谐波成像模式和基于半乳糖的造影剂（Levovist）。动态超声检查旨在通过团注造影剂后获得的一系列图像，获取局灶性病变的血管期（由动脉期和门静脉期组成）图像以及整个肝脏的肝实质期图像。
如果将全肿瘤或镶嵌式强化模式（动脉期）和/或网状强化（实质期）视为肝细胞癌的阳性表现，在我们的研究中，动态超声检查的敏感性、特异性和阳性预测值分别为92%、96%和96%。如果将环形强化（动脉期至门静脉期）或清晰缺损（实质期）或两者均视为胆管细胞癌或转移瘤的阳性表现，其敏感性、特异性和阳性预测值分别为90%、95%和88%。如果将水坑样强化（门静脉期）视为血管瘤的阳性表现，其敏感性、特异性和阳性预测值分别为60%、100%和100%。此外，在肝实质期未显示局灶性征象的肿瘤均为良性病变，如血管瘤或局灶性脂肪 sparing 区域。
在结合脉冲反转谐波成像和静脉团注造影剂的方案中，动态超声检查被证明是一种用于肝脏肿瘤特征描述的有效工具。
