彩色多普勒血流显像及超声造影在肝局灶性结节增生中的诊断价值

摘要/Abstract

摘要： 目的探究彩色多普勒血流显像及超声造影在肝局灶性结节增生中的诊断价值。方法选取确诊为肝局灶性结节增生患者32例进行回顾性分析,观察增生结节的彩色多普勒血流显像及超声造影特征。结果超声造影显示,病灶于12～16 s内开始增强,32例患者动脉相均为快速增强,且为均匀高增强。其中24例为中央型,8例为整体型(5例偏心性增强及3例团状增强),病灶呈整体快速增强。门脉相大多数病例均为高回声,少数为等回声及低回声,其中1例可见中央瘢痕低回声;延迟相18例FNH增强呈高回声,10例呈等回声,4例呈低回声。彩色多普勒血流显像检查结果,32例患者共发现阳性病灶37个,其中28例为单发病灶,4例为多发病灶;增生结节多数位于肝右叶(位于左叶9例、位于右叶22例),分布较为均匀;肝内结节最大直径5 cm,最小直径2.5 cm,平均直径3.4 cm;肝内低回声结节4例,偏低回声结节3例,高回声结节8例,偏高回声结节14例,等回声结节2例;结节呈类圆形的26例,不规则形结节6例;19例结节的边界清晰、10例边界欠清晰、3例可见周围声晕。彩色多普勒超声检查全部病灶均可显示动脉血流信号,其中22例可显示典型的“轮辐”状分布的血流特征,全部血流均为低阻动脉血流频谱。结论超声造影和彩色多普勒血管造影能动态显示肝局灶性结节增生病灶的血流灌注情况,尤其是动脉相的“轮辐”状快速离心性增强特征,以及延迟相中央瘢痕低增强特征是FNH诊断及鉴别诊断的重要依据。

关键词: 彩色多普勒血流显像, 超声造影, 肝局灶性结节增生

Abstract: Objective To investigate the application and diagnostic value of contrast-enhanced ultrasonography (CEUS) and color Doppler flow imaging (CDFI) for hepatic focal nodular hyperplasia (FNH).Methods Thirty-two patients with FNH admitted from May 2014 to June 2015 were enrolled to receive CEUS and CDFI, and their characteristics were retrospectively analyzed.Results Among the 32 cases, CEUS showed that lesions enhancements arose at 12-16 s and quickly homogeneously perfused in arterial phase, including 24 cases of central type with spoke-like enhancements, 8 of integral type with 5 eccentric and 3 mass-like enhancements. In portal phase, most cases manifested as high echo, while a few of cases showed equal or low echo, including 1 of visible hypoechoic central scar. In delayed phase, it showed high echo in 18 cases (18/36), equal echo in 10 cases (10/32) and low echo in 4 cases (4/32). CDFI revealed 37 positive lesions in these patients, including single lesion in 28 cases (28/32) and multiple lesions in 4 cases (4/32). Most hyperplastic nodules were uniformly distributed in the right hepatic lobe. The diameter of intrahepatic nodules was 3.4 cm in average, ranging from 2.5 to 5 cm. Intrahepatic nodules were hypoechoic in 4 cases (4/32), slightly hypoechoic in 3 (3/32), hyperechoic in 8 (8/32), slightly hyperechoic in 14(14/32) and isoechoic in 2 (2/32). The nodules were roundish in 26 cases (26/32) and irregular in 6 (6/32), with clear boundaries in 19 cases (19/32), obscure in 10 (10/32) and surrounding acoustic halo in 3 cases (3/32). Color Doppler ultrasound examination showed low-resistance artery flow spectrum in all lesions, with 22 cases of typical spoke-and-wheel blood flow signals.Conclusion CEUS and CDFI dynamically demonstrates the characteristics of blood perfusion in FNH lesions, which might play crucial roles in diagnosis and differential diagnosis of FNH.

Key words: Contrast-enhanced ultrasonography; Color Doppler flow imaging; Hepatic focal nodular hyperplasia

张姝, 赵洪震, 兰海峰. 彩色多普勒血流显像及超声造影在肝局灶性结节增生中的诊断价值[J]. 肝脏, 2016, 21(5): 344-346.

ZHANG Shu, ZHAO Hong-zhen, LAN Hai-feng. Application and diagnostic value of contrast-enhanced ultrasonography and color Doppler flow imaging for hepatic focal nodular hyperplasia[J]. Chinese Hepatolgy, 2016, 21(5): 344-346.

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