Wang Wen-Ping, Ding Hong, Qi Qing, Mao Feng, Xu Zhi-Zhang, Kudo Masatoshi
Department of Ultrasound, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
World J Gastroenterol. 2003 Aug;9(8):1667-74. doi: 10.3748/wjg.v9.i8.1667.
To characterize enhancement patterns of focal hepatic lesions using C-cube gray scale sonography with a microbubble contrast agent and to evaluate its usefulness in differential diagnosis of hepatic lesions.
Fifty-four patients with 58 focal hepatic lesions were examined with Levovist-enhanced C-cube gray scale sonography. The final diagnosis of hepatic lesions was 29 primary liver cancers, 4 metastases, 8 hemangiomas, 12 focal nodular hyperplasias, 2 inflammatory pseudotumors of the liver and 3 angiomyolipomas. The initiation time of enhancement in various lesions and enhancement duration after administration of contrast agent were compared. Vascular findings in lesions were classified as peripheral enhancement, homogenous enhancement, mosaic enhancement and no enhancement depending on microbubble signals in the lesion relative to the liver parenchyma.
The initiation time of enhancement in hemangioma (48+/-12 s) was significantly later compared to other lesions (P<0.05). The enhancement duration of malignancies (69+/-33 s in primary liver cancer, 61+/-23 s in metastasis) was significantly shorter compared to benign lesions (P<0.05). Intranodular enhancement appearing at arterial phase and decreasing at portal venous phase was considered characteristic for malignancy. Intranodular enhancement did not appear earlier than the liver parenchyma, and peripheral enhancement pattern was regarded as positive findings for hemangioma. Intranodular enhancement appeared in the arterial phase, and homogenous enhancement pattern sustained in the whole portal venous phase were regarded as positive findings for focal nodular hyperplasia. No microbubble signals appeared in two inflammatory pseudotumors of the liver.
C-cube gray scale sonography can demonstrate dynamic intranodular enhancement in various focal hepatic lesions. The information provided by this methodology may be useful in the differential diagnosis of hepatic lesions.
利用带有微泡造影剂的C立方灰阶超声检查法描绘肝脏局灶性病变的增强模式，并评估其在肝脏病变鉴别诊断中的效用。
采用声诺维增强C立方灰阶超声检查法对54例患有58个肝脏局灶性病变的患者进行检查。肝脏病变的最终诊断结果为29例原发性肝癌、4例转移瘤、8例肝血管瘤、12例局灶性结节性增生、2例肝脏炎性假瘤和3例血管平滑肌脂肪瘤。比较了各种病变的增强起始时间以及注射造影剂后的增强持续时间。根据病变中相对于肝实质的微泡信号，将病变中的血管表现分类为周边增强、均匀增强、镶嵌样增强和无增强。
肝血管瘤的增强起始时间（48±12秒）明显晚于其他病变（P<0.05）。恶性肿瘤的增强持续时间（原发性肝癌为69±33秒，转移瘤为61±23秒）明显短于良性病变（P<0.05）。动脉期出现的结节内增强并在门静脉期减退被认为是恶性肿瘤的特征。结节内增强不早于肝实质出现，周边增强模式被视为肝血管瘤的阳性表现。动脉期出现结节内增强且在整个门静脉期持续均匀增强模式被视为局灶性结节性增生的阳性表现。2例肝脏炎性假瘤未出现微泡信号。
C立方灰阶超声检查法可显示各种肝脏局灶性病变内的动态结节内增强。该方法提供的信息可能有助于肝脏病变的鉴别诊断。
