Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander-UniversityErlangen-Nuremberg, Erlangen, Germany.
Department of Medical Informatics, Biometry and Epidemiology (IMBE), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Clin Hemorheol Microcirc. 2019;71(1):39-51. doi: 10.3233/CH-180378.
BACKGROUNDEnhancement patterns on contrast-enhanced ultrasound (CEUS) help to distinguish different liver tumors.
Assessing the diagnostic value of dynamic contrast-enhanced ultrasound (DCEUS) for the discrimination of different malignant liver lesions.
148 malignant focal liver lesions were assessed prospectively with DCEUS (hepatocellular carcinoma = HCC; cholangiocellular carcinoma = CCC; pancreatic adenocarcinoma = PCA; breast cancer = BC; colorectal cancer = CRC; melanoma = MM). Focal-nodular-hyperplasias (FNH) served as a reference for benign lesions. DCEUS-clips were recorded continuously over three minutes. DCEUS-values were compared between the tumor entities. For better inter-individual comparability, perfusion kinetics were analyzed considering the perfusion characteristics of the surrounding liver parenchyma (Relative Signal Intensity = RSI: lesion-liver tissue/liver tissue) at different points in time.
Absolute signal intensity in FNH showed a tendency towards higher values compared with malignant liver lesions [Peak Enhancement(a.u.): FNH 7111.4; HCC 549.9; CCC -6654.3; PCA -7307.9; BC -4562.4; CRC -10672.9; MM -3034.1]. Washout was significantly less in FNH versus PCA and CRC, and more pronounced and earlier in PCA and CRC versus HCC [RSI 30 seconds after PE-lesion(%): FNH +52; PCA -65; CRC -76; HCC -26]. Rise Time, Fall Time and mean-Transit-Time did not differ significantly.
DCEUS-values reflect significant differences between malignant liver lesions, especially at peak enhancement and during the washout phases.
背景
在对比增强超声（CEUS）上的增强模式有助于区分不同的肝肿瘤。
评估动态对比增强超声（DCEUS）在区分不同恶性肝病变中的诊断价值。
前瞻性评估 148 例恶性局灶性肝病变，采用 DCEUS（肝细胞癌= HCC；胆管细胞癌= CCC；胰腺腺癌= PCA；乳腺癌= BC；结直肠癌= CRC；黑色素瘤= MM）。局灶性结节性增生（FNH）作为良性病变的参考。DCEUS 剪辑在三分钟内连续记录。比较肿瘤实体之间的 DCEUS 值。为了更好地进行个体间比较，考虑到周围肝实质的灌注特征（相对信号强度= RSI：病变-肝组织/肝组织），在不同时间点分析灌注动力学。
FNH 的绝对信号强度与恶性肝病变相比呈升高趋势[峰值增强（a.u.）：FNH 7111.4；HCC 549.9；CCC-6654.3；PCA-7307.9；BC-4562.4；CRC-10672.9；MM-3034.1]。FNH 与 PCA 和 CRC 相比，洗脱量明显减少，而 PCA 和 CRC 与 HCC 相比，洗脱量更明显且更早[PE 后 30 秒 RSI 病变（%）：FNH+52；PCA-65；CRC-76；HCC-26]。上升时间、下降时间和平均传输时间没有显著差异。
DCEUS 值反映了恶性肝病变之间的显著差异，尤其是在峰值增强和洗脱阶段。
