超声造影参数成像评估肝细胞癌和肝局灶性结节增生的价值

目的 探讨超声造影参数成像评估肝细胞性肝癌(hepatocellular carcinoma,HCC)和肝局灶性结节增生(focal nodular hyperplasia,FNH)的临床应用价值.方法 随机抽取接受超声造影检查并经临床或病理确诊的HCC和FNH各30例,利用SonoLiver CAP定量软件对其进行定量分析;以病灶与周围肝实质的增强水平差值为参数进行动态血管模型(dynamic vascular patterns,DVP)参数成像,比较HCC和FNH各参数及DVP有无差异.结果 HCC和FNH的上升时间、达峰时间、平均渡越时间依次分别为(16.7±11.1)s和(21.9±9.0)s(P=0.052)、(29.9±14.1)s和(33.2±11.1)s(P=0.322)、(115.0±90.9)s和(271.5±147.6)s(P=0.000),灌注指数分别为90.4±102.5和42.6±37.1(P=0.022).DVP曲线和DVP分布图可分为三种类型:消退型、未消退型以及负向型,在DVP曲线中,HCC和FNH这三种类型分别占76.7%(23/30)和43.3%(13/30)、20.0%(6/30)和53.3%(16/30)、3.3%(1/30)和3.3%(1/30)(P=0.023);在DVP分布图中HCC和FNH这三种类型分别占66.7%(20/30)和33.3%(10/30)、30.0%(9/30)和60.0%(18/30)、3.3%(1/30)和6.7%(2/30)(P=0.033).DVP分布图中30.0%(9/30)FNH表现出特异的轮辐状填充.结论 超声造影参数成像上HCC的平均渡越时间短于FNH,灌注指数高于FNH;DVP可以直观显示增强水平快速或细微的变化.

Abstract：

Objective To investigate the usefulness of parametric imaging of contrast-enhanced ultrasound(CEUS) in evaluating hepatocellular carcinoma ( HCC) and focal nodular hyperplasia(FNH). Methods Thirty clinically or pathologically proven HCCs and 30 pathologically proven FNHs that had undergone CEUS were randomly included. SonoLiver CAP software were used to quantitatively anlalyze the CEUS and reconstruct DVP parametric images. Results The rise time, time to peak and mean transit time in HCC and FNH were (16. 7 ± 11. 1)s and (21.9±9. 0)s (P = 0. 052) ,(29. 9 ± 14. l)s and (33. 2 ±11.1)s ( P =0. 322), (115. 0±90. 9)s and (271. 5 ± 147. 6)s ( P = 0. 000),respectively. The perfusion index was 90. 4 + 102. 5 in HCC and 42. 6 + 37. 1 in FNH( P = 0. 022). DVP curve and DVP parametric image could both be divided into three types: washout, non-washout and cystic type. In DVP curve, the percentages of which were 76. 7% (23/30),20. 0% (6/30),3. 3% (1/30) in HCC, and 43. 3% (13/30) , 53. 3% (16/30) , 3. 3%(l/30) in FNH,respectively ( P = 0. 023). In DVP parametric image, the percentages of which were 66. 7%(20/30) ,30. 0%(9/30) ,3. 3%(l/30) in HCC,and 33. 3%(10/30) ,60. 0%(18/30) ,6. 7%(2/30) in FNH,respectively ( P = 0. 033). 30. 0% (9/30) of FNH had a clear spoke-wheel pattern in DVP parametric image. Conclusions In parametric imaging of CEUS, the mean transit time of HCC was shorter than that of FNH,and the perfusion index of HCC was higher than that of FNH. The DVP parametric image can display the rapid change and detail of the enhancement clearly.

Parametric imaging of contrast-enhanced ultrasound for hepatocellular carcinoma and focal nodular hyperplasia

Objective To investigate the usefulness of parametric imaging of contrast-enhanced ultrasound(CEUS) in evaluating hepatocellular carcinoma ( HCC) and focal nodular hyperplasia(FNH). Methods Thirty clinically or pathologically proven HCCs and 30 pathologically proven FNHs that had undergone CEUS were randomly included. SonoLiver CAP software were used to quantitatively anlalyze the CEUS and reconstruct DVP parametric images. Results The rise time, time to peak and mean transit time in HCC and FNH were (16. 7 ± 11. 1)s and (21.9±9. 0)s (P = 0. 052) ,(29. 9 ± 14. l)s and (33. 2 ±11.1)s ( P =0. 322), (115. 0±90. 9)s and (271. 5 ± 147. 6)s ( P = 0. 000),respectively. The perfusion index was 90. 4 + 102. 5 in HCC and 42. 6 + 37. 1 in FNH( P = 0. 022). DVP curve and DVP parametric image could both be divided into three types: washout, non-washout and cystic type. In DVP curve, the percentages of which were 76. 7% (23/30),20. 0% (6/30),3. 3% (1/30) in HCC, and 43. 3% (13/30) , 53. 3% (16/30) , 3. 3%(l/30) in FNH,respectively ( P = 0. 023). In DVP parametric image, the percentages of which were 66. 7%(20/30) ,30. 0%(9/30) ,3. 3%(l/30) in HCC,and 33. 3%(10/30) ,60. 0%(18/30) ,6. 7%(2/30) in FNH,respectively ( P = 0. 033). 30. 0% (9/30) of FNH had a clear spoke-wheel pattern in DVP parametric image. Conclusions In parametric imaging of CEUS, the mean transit time of HCC was shorter than that of FNH,and the perfusion index of HCC was higher than that of FNH. The DVP parametric image can display the rapid change and detail of the enhancement clearly.