[使用低机械指数对比增强实时超声和声诺维对肝脏局灶性病变的特征分析]

[Characterization of focal liver lesions with contrast-enhanced low MI real time ultrasound and SonoVue].

作者信息

Hohmann J, Skrok J, Puls R, Albrecht T

机构信息

Klinik und Poliklinik für Radiologie und Nuklearmedizin, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin.

出版信息

Rofo. 2003 Jun;175(6):835-43. doi: 10.1055/s-2003-39923.

DOI:10.1055/s-2003-39923

PMID:12811698

Abstract

PURPOSE

SonoVue is a new microbubble ultrasound contrast agent that for the first time allows continuous real time examination during the different phases of contrast enhancement using low transmission power, expressed as mechanical index (MI). This study investigates whether low MI real time phase inversion imaging with SonoVue can improve the characterization of focal liver lesions in comparison to unenhanced sonography and power Doppler sonography.

MATERIALS AND METHODS

Sixty-three patients with 35 malignant and 28 benign liver lesions were studied with unenhanced ultrasound (US) including B-mode and power Doppler, followed by contrast-enhanced al MI (0.1 - 0.3) real time phase inversion US during arterial, portal-venous and delayed liver phase (> 2 min after injection). Findings of the scans obtained before and after administration of contrast agent were compared with each other and with reference examinations (biopsy, MRI, CT or intraoperative US).

RESULTS

The number of correctly diagnosed lesions increased from 41 (65%) without contrast agent to 58 (92%) with contrast agent (p < 0.001). The differentiation of malignant from benign lesions improved from 43 (68 %) to 60 (95 %, p < 0.001). After administration of the contrast agent, all 35 malignant lesions were correctly recognized and 3 of the 28 benign lesions were misclassified. All 27 metastases showed little or no enhancement on portal-venous and delayed phase imaging, independent of their arterial features. All 6 hepatocellular carcinomas (HCC) enhanced markedly during arterial phase and 5 showed less contrast uptake than normal liver in the late phase. Ten of 11 hemangioma displayed arterial peripheral nodular enhancement followed by progressive centripetal fill-in. Nine of 11 focal nodular hyperplasias (FNHs) showed profuse arterial enhancement (5 with a transient "spokewheel") and contrast uptake similar to normal liver thereafter. One FNH showed a subtle central scar.

CONCLUSION

Low MI real time US with SonoVue markedly improves the characterization of focal hepatic lesions in comparison with unenhanced sonography.

摘要

目的

声诺维是一种新型微泡超声造影剂，首次能够在使用低发射功率（以机械指数（MI）表示）的情况下，在不同的增强阶段进行连续实时检查。本研究旨在探讨与未增强超声及功率多普勒超声相比，使用声诺维的低MI实时相位反转成像是否能改善肝脏局灶性病变的特征描述。

材料与方法

对63例患有35个恶性和28个良性肝脏病变的患者进行了研究，先进行包括B模式和功率多普勒的未增强超声（US）检查，随后在动脉期、门静脉期和延迟肝期（注射后>2分钟）进行低MI（0.1 - 0.3）实时相位反转超声造影增强检查。将造影剂给药前后获得的扫描结果相互比较，并与参考检查（活检、MRI、CT或术中超声）进行比较。

结果

正确诊断的病变数量从无造影剂时的41个（65%）增加到有造影剂时的58个（92%）（p < 0.001）。恶性病变与良性病变的鉴别从43个（68%）提高到60个（95%，p < 0.001）。给予造影剂后，35个恶性病变全部被正确识别，28个良性病变中有3个被错误分类。所有27个转移瘤在门静脉期和延迟期成像中显示很少或无增强，与其动脉期特征无关。所有6个肝细胞癌（HCC）在动脉期均有明显增强，5个在晚期对比剂摄取低于正常肝脏。11个血管瘤中有10个表现为动脉周边结节状增强，随后逐渐向心性填充。11个局灶性结节性增生（FNH）中有9个表现为丰富的动脉期增强（5个有短暂的“辐条轮”表现），之后对比剂摄取与正常肝脏相似。1个FNH显示有细微的中央瘢痕。