【作者】 张凤娟； 赵玉珍； 杨漪；

【Author】 Zhang Feng-Juan, Zhao Yu-Zhen, Yang Yi The Fourth Hospital of Hebei Medical University, The Tumor hosipital of Hebei province

【机构】 河北医科大学第四医院河北省肿瘤医院超声科；

【摘要】 目的:探讨定量指标血流平均密度(MFD)在评价肝肿瘤超声造影前后血供情况的临床应用价值。方法:本研究选取2003年8月-2004年12月住院或门诊就诊的肝肿瘤患者35例(原发性肝癌11例,转移癌9例,肝血管瘤15例),男 21例,女14例,年龄24—72岁,平均(50±7．8)岁。病灶直径范围1．5cm-11cm,平均(3．8±0．8)cm。11例原发性肝癌均经手术病理证实,其余病例通过增强CT、MRI,结合临床及实验室相关指标证实。采用Philips HDI 5000型超声诊断仪,C5—2宽频凸阵探头。常规显像采用Abd／Gen软件,彩色增益在72％-76％。超声造影显像采用Con／Gen软件,机械指数调定为0．08。所有病灶造影前后各参数均设置为同一标准。超声造影剂SonoVue(BRACCO公司生产)为六氟化硫(SF6)的冻干制剂。使用前先将5．0ml生理盐水注入内装59mg SonoVue粉末的小瓶中,摇动20s晃匀后备用。常规经二维超声检测肝内病灶,记录其大小、形态、内部回声等,选取显像理想的病灶作为研究目标。应用能量多普勒显示其血流分布,将图像存入MO。在病灶血流显示理想切面状态下切换至造影状态。将已配好的SonoVue摇动5s后抽取2．4ml经患者肘静脉注入(采用团注法3s完成)随即注入生理盐水5．0ml(3s完成)。实时动态观察血流信号的显示过程,全部图像存入录像带和MO。应用计算机图像分析软件 Auto CAD 2004计算血流平均密度(MFD),选择造影前病灶CPA显示及造影后10s至15s(动脉相)灰阶显示最理想的血流图像,分别计算肿瘤区域血流面积与肿瘤区域有效面积(肿瘤切面总面积减去液化坏死区域的面积),二者之比即得MFD,将其作为反映肝肿瘤血供丰富程度的定量指标。所有计测数据以(±s)表示,应用SPSS 12．0进行统计学分析。各组造影前后比较采用配对t检验,造影后各组间比较应用单因素成组设计方差分析,以P<0．05为差异有统计学意义。结果: 各组造影前与造影后MFD比较差异有统计学意义(P<0．05),造影后HCC组MFD(0．303±0．179), 明显高于HCH组(0．093±0．064),两组间比较差异有统计学意义(P<0．05)。造影后MLT组分别与HCC组和HCH 组比较,差异均无统计学意义(P>0．05)。结论:超声造影能提高不同性质肝肿瘤的血流信号,血流定量指标MFD能对肝癌与肝血管瘤的鉴别诊断提供有价值的信息。更多还原

【Abstract】 Objective: To explore the clinical application of quantitative index - MFD (mean flow density) before and after contrast-enhanced ultrasound (CEUS) in evaluating the blood supply of hepatic tumor. Methods: Thirty-five hepatic solid lesions(l 1 cases of hepatocellular carcinomas HCC, 9 cases of metastatic liver tumors MLT, 15 cases of hepatic hemangiomas HCH) were examined with color power angiography (CPA) before enhanced ultrasonography, then they were examined with Pulse-inversion harmonic (PIH) ultrasonographic imaging after an intravenous administration of SonoVue. First, the position, size, shape and inner echo of tumors were detected with 2D gray-scale. Second, the blood flows supply of tumors were displayed with basic wave CPA and the distribution of tumors’ vessels was observed at the same time. Third, the distribution of tumors’ vessels were observed in the best enhanced state of arterial phase after injection of ultrasound contrast agent (UCA). The mean flow density (MFD) was the quantitative index of blood flows with ba- sic wave CPA and in the best enhanced state of arterial phase after CEUS, which was calculated using Auto CAD2004. Results: The blood flows of 35 cases of hepatic benign and malignant tumors displayed in the best enhanced state of arterial phase were more than with basic wave CPA, the MFD of every group was significant difference before and after CEUS (P<0.05). The MFD of 11 cases of hepatocelluar carcinoma (HCC) was obviously different from the MFD of 15 cases hepatic haemangiomas (HCH), there was significant difference between the two groups in the arterial phase of CEUS (P<0.05). There was no signiflcant difference when the MFD of 9 cases of MLT compared respectively with the MFD of HCC and HCH (P>0.05) after CEUS. Conclusions: CEUS could significantly enhance the signal of blood flows in hepatic tumors, show the tiny vessels and truly reflect the growth and distribution of tumors’ vessels. Doing quantitative analysis for the blood flows of hepatic benign and malignant tumors in the arterial phase and calculating the MFD of tumors could provide the better evidence for differentiate diagnosis of hepatic benign and malignant tumors.更多还原