肝脏血管瘤的多模态超声影像特征及其诊断效能研究

摘要/Abstract

摘要： 目的利用多种超声模态特征进行联合分析,为肝脏血管瘤(HH)定性诊断提供更加准确、客观的依据。方法纳入2022年1月至2024年8月期间经病理检查诊断为HH患者122例,同时收集同期肝细胞癌(HCC)患者80例。比较HH、HCC各模态超声影像特征及其对HH的诊断效能。结果与HCC组相比,HH组常表现为内部回声均匀、边缘裂隙征明显及内部网格样回声结构,差异均具有统计学意义(P<0.05);同时HH组后方回声增强和非钙化性后方声影的发生率显著高于HCC组(P<0.05);此外HH病灶在探头加压下易发生形变,提示其内部组织较为柔软、可压缩,而HCC病灶质地坚硬、形变受限。HH病灶内血流信号较少且多为轨道征血流分布,而HCC病灶以血流信号丰富和中央型血流为主要特征;HH组血流频谱多呈低速静脉样频谱,峰值流速明显低于HCC组(P<0.05)。HH病灶杨氏模量值和杨氏模量比值(瘤体/肝)均显著低于HCC组(P<0.05);HH病灶多呈蓝/绿色低弹性模式,且常见“边缘高-中心低”弹性分布,与其中心血窦扩张、周边纤维化的组织结构一致,而HCC病灶以马赛克征为主,反映肿瘤内部组织硬度不均、坏死与新生血管共存的特征。HCC病灶以“快进快出”增强模式为主,而HH病灶多表现为动脉期周边结节样强化、向心性充盈及动脉期黑洞征;在门静脉期,HH向心填充达50%的时间显著长于HCC(P<0.05),延迟期仍呈等或高增强。通过结合二维灰阶结构特征、CDFI血流信号、SWE弹性参数及CEUS动态灌注模式的多模态联合诊断,可显著提高HH、HCC的鉴别效能。结论 HH在二维灰阶超声、CDFI、SWE及CEUS各模态下均具有特征性表现。多模态超声联合分析能够提升HH诊断灵敏度和特异度,为肝脏良恶性占位性病变的鉴别提供更加全面、可靠的影像学依据。

关键词: 肝脏血管瘤, 肝细胞癌, 彩色多普勒血流成像, 剪切波弹性成像, 超声造影

Abstract: Objective To perform a comprehensive analysis of multiple ultrasonographic modalities and provide a more accurate andObjective basis for the qualitative diagnosis of hepatic hemangioma (HH). Methods A total of 122 patients with pathologically confirmed HH and 80 patients with hepatocellular carcinoma (HCC) admitted between January 2022 and August 2024 were enrolled. The ultrasonographic features of HH and HCC under different imaging modalities were compared, and their diagnostic performance for HH was evaluated. Results Compared with the HCC group, HH lesions more frequently exhibited homogeneous internal echotexture, a distinct marginal fissure sign, and reticular internal echoes (P<0.05). The incidence of posterior acoustic enhancement and non-calcified posterior acoustic shadowing was also significantly higher in the HH group (P<0.05). In addition, HH lesions were more deformable under probe compression, indicating a softer and more compressible texture, whereas HCC lesions were firm and resistant to deformation. On color Doppler flow imaging (CDFI), HH lesions showed sparse blood flow signals predominantly with a “track-like” pattern, while HCC lesions demonstrated abundant blood flow and a central flow pattern. The venous-like low-velocity spectrum was more common in HH, and the peak flow velocity was significantly lower than that of HCC (P<0.05). Shear wave elastography (SWE) revealed that both the Young’s modulus value and tumor-to-liver elasticity ratio of HH were significantly lower than those of HCC (P<0.05). HH lesions predominantly displayed blue/green low-elasticity patterns with a “high-peripheral-low-central” distribution, consistent with the histological characteristics of central cavernous dilation and peripheral fibrosis. In contrast, HCC lesions primarily presented a mosaic pattern, reflecting heterogeneous stiffness due to necrosis and neovascularization. On contrast-enhanced ultrasound (CEUS), HCC lesions mainly exhibited a “fast-in and fast-out” enhancement pattern, whereas HH lesions typically showed peripheral nodular enhancement in the arterial phase, centripetal filling, and the “black hole sign”. During the portal phase, the time required for HH lesions to achieve 50% centripetal filling was significantly longer than that of HCC (P<0.05), and HH maintained iso- or hyper-enhancement in the delayed phase. The combined multimodal diagnostic approach integrating B-mode structural features, CDFI hemodynamics, SWE elasticity parameters, and CEUS perfusion patterns markedly improved the differentiation between HH and HCC. Conclusion HH exhibits characteristic imaging features across B-mode, CDFI, SWE, and CEUS modalities. Multimodal ultrasonographic analysis significantly enhances the sensitivity and specificity for diagnosing HH, providing a more comprehensive and reliable imaging basis for differentiating benign and malignant hepatic lesions.

Key words: Hepatic hemangioma, Hepatocellular carcinoma, Color doppler flow imaging, Shear wave elastography, Contrast-enhanced ultrasound

施静, 周锋盛, 朱巧英, 展莉莉. 肝脏血管瘤的多模态超声影像特征及其诊断效能研究[J]. 肝脏, 2025, 30(12): 1664-1667.

SHI Jing, ZHOU Feng-sheng, ZHU Qiao-ying, ZHAN Li-li. Multimodal ultrasonographic features and diagnostic performance of hepatic hemangioma[J]. Chinese Hepatolgy, 2025, 30(12): 1664-1667.

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