肝脏孤立性坏死结节与单发性转移性肝癌在超声造影中表现的差异分析

摘要/Abstract

摘要： 目的探讨应用超声造影技术对肝脏孤立性坏死结节(SNNL)、单发性转移性肝癌(SMHC)诊断表现差异。方法选取2014年1月至2018年12月于成都医学院第二附属医院及四川大学华西医院住院期间行肝脏超声造影检查患者31例,患者均经超声引导下病灶穿刺活检或手术后病理证实为SNNL或SMHC,统计学分析采用t检验或卡方检验。结果 SNNL患者6例,SMHC患者25例。SNNL组患者年龄为(43.8±7.2)岁,明显低于SMHC组患者的(59.7±11.2)岁(P<0.05)。SNNL组病灶边界清楚5例,边界模糊1例;SMHC组患者病灶边界清楚8例,边界模糊17例,两组患者病灶边界情况差异有统计学意义(P<0.05)。动脉相时,超声造影中SNNL组患者病灶提示周边高增强环厚度为1.1～4.8 mm,平均厚度为(2.4±0.8)mm;SMHC组患者病灶提示周边高增强环厚度为3.3～9.2 mm,平均厚度为(5.1±1.3)mm,两组患者病灶增强环厚度差异有统计学意义(P<0.05)。延迟相时[(6.1±4.2)cm]SNNL组患者病灶无增强区域与动脉相时[(8.0±6.5)cm]差异无统计学意义(P>0.05);延迟相时[(6.3±2.9)cm]SMHC组患者病灶无增强区域明显大于动脉相时[(2.8±3.6)cm],且差异有统计学意义(P<0.05)。结论超声造影动脉相时病灶周边高增强环厚度、延迟相时病灶无增强区域范围等差异有助于区分SNNL及SMHC。

关键词: 肝脏孤立性坏死结节, 单发性转移性肝癌, 超声造影, SonoVue超声造影剂

Abstract: Objective Contrast-enhanced ultrasound (CEUS) was used to investigate the difference of diagnostic performance between solitary necrotic nodule of the liver (SNNL) and single metastatic liver cancer (SMHC).Methods The patients pathologically diagnosed SNNL or SMHC by ultrasound-guided puncture biopsy or operation, who underwent CEUS for liver during hospitalization in the second Affiliated Hospital of Chengdu Medical College and West China Hospital of Sichuan University from January 2014 to December 2018 were enrolled. The measurement data were expressed as (±s), analyzed by t-test. And the counting data were expressed as absolute numbers, analyzed by chi-square test. Results A total of 31 patients were enrolled in the study, including 14 males and 17 females, with an average age of (52.6±7.9) years. There were 6 patients with SNNL and 25 patients with SMHC. The average age of patients with SNNL was significantly lower than that of patients with SMHC [(43.8±7.2) years, (59.7±11.2) years, P<0.05]. In SNNL group, there were 5 cases with clear lesion boundary and 1 case with fuzzy lesion boundary. In SMHC group, there were 8 cases with clear lesion boundary and 17 cases with fuzzy lesion boundary. There was significant difference between the 2 groups (P<0.05). In arterial phase, the thickness of the highly-enhanced peripheral ring was between 1.1 and 4.8 mm, with an average of (2.4±0.8) mm in SNNL group, and was between 3.3 and 9.2 mm, with an average of (5.1±1.3) mm in SMHC group. There was significant difference in the thickness of the highly-enhanced peripheral ring between the 2 groups (P<0.05). In SNNL group, there was no significant difference between area without enhancement in delayed and arterial phases [(6.1±4.2) cm, (8.0±6.5) cm, P>0.05]. However, in SMHC group, there was significant difference between area without enhancement in delayed and arterial phases [(6.3±2.9) cm, (2.8±3.6) cm, P<0.05].Conclusion CEUS is helpful to distinguish SNNL from SMHC, with differences in the thickness of highly-enhanced ring around the lesion in arterial phase and the range of non-enhancement area in delayed phase.

Key words: Solitary necrotic nodule of the liver, Single metastatic liver cancer, Contrast-enhanced ultrasound, SonoVue contrast agent

李景, 张明智, 刘家开, 石波, 罗利. 肝脏孤立性坏死结节与单发性转移性肝癌在超声造影中表现的差异分析[J]. 肝脏, 2020, 25(5): 483-485.

LI Jing, ZHANG Ming-zhi, LIU Jia-kai, SHI Bo, LUO Li. Analysis of the difference between solitary necrotic nodule of the liver and single metastatic liver cancer in contrast-enhanced ultrasound[J]. Chinese Hepatolgy, 2020, 25(5): 483-485.

参考文献

[1] Fang J, Ma X, Yu D, et al. Specific imaging characteristic of solitary necrotic nodule of the liver: marked peripheral rim-like enhancement with internal hypointensity on longer delayed MRI. Eur Radiol, 2017, 27:3563-3573.
[2] Wong KM, Tay TK, Poh WT, et al. Solitary necrotic nodule of the liver: radiologic-pathologic correlation in a case with unusual imaging features. Jpn J Radiol, 2013, 31:277-281.
[3] Geng L, Lin C, Huang B, et al. Solitary necrotic nodule of the liver: MR findings in 33 pathologically proved lesions. Eur J Radiol, 2012, 81:623-629.
[4] 俞顺,方主亭,包强,等. 肝脏孤立性坏死结节的MRI特征与病理对照.中国医学影像学杂志,2013, 21:641-643.
[5] Wang Y, Yu X, Tang J, et al. Solitary necrotic nodule of the liver: contrast-enhanced sonography. J Clin Ultrasound, 2007, 35:177-181.
[6] Wang LX, Liu K, Lin GW, et al. Solitary necrotic nodules of the liver: histology and diagnosis with CT and MRI. Hepat Mon, 2012, 12:e6212.
[7] Colagrande S, Paolucci ML, Messerini L, et al. Solitary necrotic nodules of the liver: cross-sectional imaging findings and follow-up in nine patients. AJR Am J Roentgenol, 2008, 191:1122-1128.
[8] Chen CJ, Chou SC, Chen HJ, et al. Solitary necrotic nodule with larval infestation in the liver on F-18 FDG PET/CT. Clin Nucl Med, 2010, 35:724-725.
[9] Patti R, Cabibi D, Sparacello M, et al. Solitary necrotic nodule of the liver: different pathological findings express a different histogenesis. Case Rep Gastroenterol, 2008, 2:149-154.
[10] 邵丹丹,王雪雪,赵骞,等. 肝脏孤立性坏死结节的MRI和CT诊断及鉴别诊断. 放射学实践,2015, :845-848.
[11] 邵丹丹,王雪雪,赵骞,等.肝脏孤立性坏死结节的MR表现(40例). 中国医学计算机成像杂志,2015, 21:241-245.
[12] 倪晓蔑,周环宇,魏向东,等. 肝脏孤立性坏死结节的超声造影表现. 中华医学超声杂志:电子版,2011,8:1451-1456.
[13] 黄泽萍,王平,郑荣琴,等.常规超声检查与超声造影对肝脏局灶性病变检出能力的比较.中华肝脏外科手术学电子杂志,2013,2:29-33.
[14] Celli N, Gaiani S, Piscaglia F, et al. Characterization of liver lesions by real-time contrast-enhanced ultrasonography. Eur J Gastroenterol Hepatol, 2007, 19:3-14.
[15] Dietrich CF, Tana C, Caraiani C, et al. Contrast enhanced ultrasound (CEUS) imaging of solid benign focal liver lesions. Expert Rev Gastroenterol Hepatol, 2018, 12:479-489.