Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2, Canada.
AJR Am J Roentgenol. 2020 Jun;214(6):1295-1304. doi: 10.2214/AJR.19.21498. Epub 2020 Mar 17.
CT or MRI is most commonly used for characterizing focal hepatic lesions. However, findings on CT and MRI are occasionally indeterminate. Contrast-enhanced ultrasound (CEUS), with its unique characteristics as a purely intravascular contrast agent and real-time evaluation of enhancement, is a useful next step. The purpose of this article is to review the evidence for performing CEUS in the assessment of indeterminate hepatic lesions seen on CT and MRI. CEUS is a useful problem-solving tool in the evaluation of liver lesions that are indeterminate on CT and MRI. Uses include detection of arterial phase hyperenhancement; differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma; determination of benign versus malignant tumor thrombus, benign versus neoplastic cystic hepatic lesions, and hepatocellular adenoma versus focal nodular hyperplasia; and monitoring for recurrence in postablative therapies. CEUS can help establish a confident diagnosis and determine the need for further invasive diagnosis or treatment.
CT 或 MRI 是最常用于描述局灶性肝病变的方法。然而，CT 和 MRI 的结果偶尔会出现不确定的情况。对比增强超声（CEUS）作为一种独特的纯血管内造影剂，具有实时增强评估的特点，是下一步有用的方法。本文的目的是回顾在评估 CT 和 MRI 上所见的不确定肝病变中进行 CEUS 的证据。CEUS 是评估 CT 和 MRI 上不确定的肝病变的一种有用的解决问题的工具。其用途包括检测动脉期增强；区分肝细胞癌和肝内胆管细胞癌；确定良恶性肿瘤栓子、良性与肿瘤性囊性肝病变、肝细胞腺瘤与局灶性结节性增生的区别；以及监测消融治疗后的复发情况。CEUS 有助于建立明确的诊断，并确定是否需要进一步的有创诊断或治疗。
