摘要
目的探讨在肝硬化基础上的肝内胆管细胞癌的实时超声造影与增强螺旋CT的成像特征。方法经病理确诊的胆管细胞癌并肝硬化的患者12例(手术切除11例,穿刺1例),11例采用对比脉冲造影技术,1例采用连续脉冲反向谐波造影技术,机械指数<0.2,2.4mL造影剂SonoVue团注。将超声造影与增强CT的增强模式、术前诊断与病理结果进行对比分析。结果超声造影动脉相5例(41.7%)为不均匀高增强,3例(25.0%)为均匀高增强,4例(33.3%)为周边环状增强。超声造影3例(25.0%)诊断为肝内胆管细胞癌,9例(75.0%)诊断为肝细胞癌。增强CT动脉期10例(83.3%)为不均匀强化,2例(16.7%)为环状强化。2例(16.7%)诊断为肝内胆管细胞,10例(83.3%)诊断为肝细胞癌。结论肝硬化基础上的多数肝内胆管细胞癌实时超声造影与增强螺旋CT的增强模式与肝细胞癌类似,影像学鉴别诊断困难。
Objective To analyze the enhancement pattern by contrast-enhanced ultrasound （CEUS） and contrast-enhanced helical CT （CECT） of intrahepatic peripheral cholangiocarcinoma in the patients with cirrhosis. Methods Twelve patients with pathologically proven intrahepatic peripheral cholangiocarcinoma and cirrhosis were included in this study. Low mechanical index （mechanical index less than 0.2） of real-time CEUS was performed in 12 patients （11 patients with contrast pulse sequencing, CPS, 1 patient with pulse inversion harmonic） after 2.4ml bolus injection of contrast agent-SonoVue. CECT was performed by 16-slice helical CT and contrast agent Ultravist. The enhancement patterns of CEUS and CECT were analyzed. The diagnosis of CEUS and CECT were compared with histologic results before operation. Results The tumor was shown irregular rim-like hyperenhancement in 4 patients, heterogeneous hyperenhancement in 5 patients and homogeneous hyperenhancement in 3 patients in the arterial phase by CEUS. Nine patients were misdiagnosed as hepatocellular carcinoma, and only 3 patients were correctly diagnosed as cholangiocarcinoma. The tumor was presented as irregular rim-like hyperenhancement in only 2 patients, heterogeneous hyperenhancement in the other 10 patients in the arterial phase by CECT. Only 2 patients were correctly diagnosed as cholangiocarcinoma,and 10 patients were misdiagnosed as hepatocellular carcinoma by CECT. The diagnostic accuracy was only 25% by CEUS and 16.7% by CECT before operation. Conclusions Majority of intrahepatic cholangiocarcinoma in patients with cirrhosis may show an enhancement pattern similar to hepatocellular carcinoma by CEUS and CECT.
出处
《中华医学超声杂志（电子版）》
2011年第7期19-21,共3页
Chinese Journal of Medical Ultrasound(Electronic Edition)
关键词
超声检查
肝硬化
肝内胆管细胞癌
增强CT
Ultrasonography
Liver cirrhosis
Intrahepatic cholangiocarcinoma
Contrast-enhanced CT
