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目的探讨肝复杂背景下不典型肝血管瘤超声造影的增强模式,评价超声造影对肝血管瘤的诊断价值。方法应用造影剂SonoVue及CnTI造影成像技术对352例肝占位病变行超声造影检查,回顾性分析其中39例49灶肝血管瘤的超声造影增强表现。全部病例经增强CT、MRI、肝血池显像或穿刺活检等确诊。结果49个肝血管瘤造影后增强表现可分为四种模式:模式Ⅰ,病灶呈周边细环伴小结节状增强并呈向心性填充(26灶);模式Ⅱ,呈粗环状增强并向心性填充(15灶);模式Ⅲ,呈轻度缓慢增强或无增强(6灶);模式Ⅳ,呈不规则整体增强(2灶)。本组有8个灶延迟期可见轻度退出,其中6个灶为模式Ⅱ,2个灶为模式Ⅳ。本组病灶造影前仅2个灶(4.0%)被诊断为血管瘤,超声造影后35个灶(71.4%)被确诊为血管瘤。未能诊断为血管瘤的病灶中≤3cm者占78.6%(11/14)。结论常规超声诊断困难的血管瘤超声造影后根据其典型增强模式,多数可作出明确的诊断或排除恶性;但对延迟期有轻度退出者需结合增强CT或穿刺活检等其他检查以除外恶性。
Objective To investigate the enhancement mode of atypical hepatic hemangiomas contrast-enhanced echocardiography in complicated liver and to evaluate the value of contrast-enhanced ultrasound in the diagnosis of hepatic hemangiomas. Methods SonoVue and CnTI contrast-enhanced radiography were used to detect 352 cases of hepatic space-occupying lesions underwent contrast-enhanced ultrasound. Retrospective analysis of 39 cases of hepatic hemangiomas with enhancement of contrast-enhanced ultrasound was performed. All cases were confirmed by enhanced CT, MRI, liver blood pool imaging or biopsy. Results The enhanced manifestations of 49 hepatic hemangiomas after angiography were classified into four modes: mode Ⅰ, the lesion showed small nodules around the foci and focal filling (26 foci); mode Ⅱ, Focal filling (15 stoves); mode Ⅲ, with mild slow or no enhancement (6 stoves); Mode IV, with irregular overall enhancement (stoves 2). This group of eight stoves showed a slight delay in the exit phase, of which six stoves for the mode Ⅱ, 2 stoves for the mode Ⅳ. Only 2 foci (4.0%) were diagnosed as hemangiomas before angiography, and 35 lesions (71.4%) were confirmed as hemangiomas after contrast-enhanced ultrasound. Among the lesions that failed to be diagnosed as hemangiomas, 78% (11/14) of them were ≤3 cm. Conclusion Conventional ultrasonic diagnosis of difficult angiography according to its typical enhancement mode, the majority can make a clear diagnosis or exclude malignancy; but for those with a slight delay in the delay should be combined with enhanced CT or biopsy and other tests to exclude malignancy.