Wilson Stephanie R, Burns Peter N
Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
AJR Am J Roentgenol. 2006 May;186(5):1401-12. doi: 10.2214/AJR.04.1920.
The objective of this study was to develop an algorithm for liver mass diagnosis using microbubble contrast-enhanced pulse-inversion sonography.
Ninety-six lesions in 92 patients were evaluated with DMP 115 (Definity)-enhanced pulse-inversion sonography, comprising 44 malignancies (29 hepatocellular carcinomas, 12 metastases, two peripheral cholangiocarcinomas, and one hepatic lymphoma) and 52 benign lesions (26 hemangiomas, 20 focal nodular hyperplasias, and six others). All had continuous low-mechanical-index imaging through the arterial and portal venous phase. A three-person blind review evaluated single images at baseline, early and peak arterial phases, and through the extended portal phases with a movie showing arterial phase wash-in. Reviewers assessed lesional vascularity and enhancement blindly but did not make a diagnosis. Combinations of answers were compared with independently determined final diagnoses to develop an algorithm for liver mass diagnosis.
Portal phase enhancement comprises the first step of the algorithm, with positive or sustained enhancement identifying 48 (92%) of 52 benign lesions and negative enhancement or washout present in 41 (93%) of 44 malignancies. Sustained portal phase enhancement with arterial phase peripheral nodularity and centripetal progression predicted 24 (92%) of 26 of the hemangiomas; diffuse arterial phase enhancement greater than the liver identified 19 (95%) of 20 of the focal nodular hyperplasias. With negative portal phase enhancement, arterial phase information was less effective at differentiating hepatocellular carcinoma (25 [86%] of 29 cases) from another hepatic malignancy (11 [73%] of 15 cases).
A simple diagnostic algorithm for interpretation of microbubble-enhanced sonography provides sensitive and accurate diagnosis of commonly encountered liver masses.
本研究的目的是开发一种使用微泡对比增强脉冲反转超声检查进行肝脏肿块诊断的算法。
对92例患者的96个病灶进行了DMP 115（Definity）增强脉冲反转超声检查，其中包括44个恶性肿瘤（29个肝细胞癌、12个转移瘤、2个周围胆管癌和1个肝淋巴瘤）和52个良性病灶（26个血管瘤、20个局灶性结节性增生和6个其他病灶）。所有患者均在动脉期和门静脉期进行了连续的低机械指数成像。由三人进行盲法评估，在基线、动脉早期和峰值期以及通过扩展门静脉期的单幅图像，并观看显示动脉期强化的动态图像。评估者对病灶血管和强化情况进行盲法评估，但不做出诊断。将答案组合与独立确定的最终诊断进行比较，以开发肝脏肿块诊断算法。
门静脉期强化是该算法的第一步，52个良性病灶中有48个（92%）表现为阳性或持续强化，44个恶性肿瘤中有41个（93%）表现为阴性强化或廓清。门静脉期持续强化伴动脉期周边结节和向心性进展可预测26个血管瘤中的24个（92%）；动脉期弥漫性强化大于肝脏可识别20个局灶性结节性增生中的19个（95%）。门静脉期强化为阴性时，动脉期信息在区分肝细胞癌（29例中的25例[86%]）和其他肝脏恶性肿瘤（15例中的11例[73%]）方面效果较差。
一种用于解读微泡增强超声检查的简单诊断算法可对常见肝脏肿块进行敏感且准确的诊断。
