肝脏肿瘤中增强的彩色血流信号。

Yang Chi-Chieh, Chen Chien-Hua, Yeh Yung-Hsiang

Division of Gastroenterology, Department of Internal Medicine, Changhua Show-Chwan Memorial Hospital, Changhua, Taiwan, ROC.

Hepatogastroenterology. 2002 Nov-Dec;49(48):1506-9.

BACKGROUND/AIMS: The study was to utilize both color Doppler sonography and power Doppler sonography to analyze the enhancement characteristics of hepatic tumors known to have a clinical or histologically confirmed diagnosis of hepatocellular carcinoma, hemangioma, or focal nodular hyperplasia.

METHODOLOGY

Twenty-two hepatocellular carcinomas, 6 hemangiomas, and 2 focal nodular hyperplasias were observed with color Doppler sonography and power Doppler sonography before and after contrast agent (Levovist) administration. Color Doppler sonography and power Doppler sonography were used to detect the intratumoral vasculature and their sensitivity would be evaluated.

RESULTS

Significant improvement in the detection of color flow signals was obtained in hepatocellular carcinomas after administering Levovist (32% (7/22) vs. 91% (20/22); p = 0.0002), but it was not significant in hemangiomas (0% (0/6) vs. 33% (2/6); p = 0.454). Power Doppler sonography was more sensitive than color Doppler sonography in the detection of flow signals in hepatocellular carcinomas after administering Levovist (91% (20/22) vs. 50% (11/22); p = 0.008). Eighty percent (16/20) of hepatocellular carcinomas had signals of curvilinear type versus spotty type (p = 0.0005), the detected signal in both hemangiomas was iris diaphragm phenomenon. The typical spoke-wheel appearance of focal nodular hyperplasia was more easily demonstrated after administering Levovist. The hepatocellular carcinomas with absent baseline flow (1.2-5.6 cm, mean: 3.1 +/- 1.0 cm) tended to be smaller than the hepatocellular carcinomas with baseline flows (2.3-8.3 cm, mean: 4.9 +/- 2.2 cm) (p = 0.06). The 9 hepatocellular carcinomas (largest diameter: 1.2-3.8 cm, mean: 2.6 +/- 0.8 cm) with enhanced flows only observed by power Doppler sonography was smaller than the 11 hepatocellular carcinomas (largest diameter: 2.3-8.3 cm, mean: 4.5 +/- 1.8 cm) with enhanced flows observed by color Doppler sonography and power Doppler sonography (p = 0.01).

CONCLUSIONS

Enhanced color flow study may aid in the detection of flow signals or sonographic differentiation of hepatic tumors.

背景/目的：本研究旨在利用彩色多普勒超声和能量多普勒超声分析已通过临床或组织学确诊为肝细胞癌、肝血管瘤或局灶性结节性增生的肝脏肿瘤的增强特征。

方法

对22例肝细胞癌、6例肝血管瘤和2例局灶性结节性增生在注射造影剂（Levovist）前后进行彩色多普勒超声和能量多普勒超声检查。使用彩色多普勒超声和能量多普勒超声检测肿瘤内血管，并评估其敏感性。

结果

注射Levovist后，肝细胞癌的彩色血流信号检测有显著改善（32%（7/22）对91%（20/22）；p = 0.0002），但在肝血管瘤中不显著（0%（0/6）对33%（2/6）；p = 0.454）。注射Levovist后，能量多普勒超声在检测肝细胞癌血流信号方面比彩色多普勒超声更敏感（91%（20/22）对50%（11/22）；p = 0.008）。80%（16/20）的肝细胞癌具有曲线型信号而非斑点型信号（p = 0.0005），两种肝血管瘤中的检测信号均为虹膜隔膜现象。注射Levovist后，局灶性结节性增生的典型辐轮状外观更易显示。基线血流缺失的肝细胞癌（1.2 - 5.6 cm，平均：3.1 +/- 1.0 cm）往往比有基线血流的肝细胞癌（2.3 - 8.3 cm，平均：4.9 +/- 2.2 cm）小（p = 0.06）。仅通过能量多普勒超声观察到血流增强的9例肝细胞癌（最大直径：1.2 - 3.8 cm，平均：2.6 +/- 0.8 cm）比通过彩色多普勒超声和能量多普勒超声观察到血流增强的11例肝细胞癌（最大直径：2.3 - 8.3 cm，平均：4.5 +/- 1.8 cm）小（p = 0.01）。