目的 探讨超声造影成像技术在早期肝癌诊断中的临床应用价值,分析影响超声造影诊断准确率的因素.方法 本研究纳入2012年5月至2015年5月本院收治的肝硬化合并肝内小占位性病变患者215例(236个病灶),并对其进行超声造影检查,所有病灶直径均<3 cm,造影检查结束15天内行穿刺活检病理诊断.对比超声造影诊断与病理诊断结果,分析良性结节与恶性结节超声造影特征及造影相关指标,讨论导致误诊和漏诊的因素.结果 超声造影诊断灵敏度为93.14%,特异度为95.52%,诊断符合率为94.49%.小肝癌典型造影特征为"快进快出",肝硬化结节典型造影特征为门脉相与延迟相与邻近肝组织同步显影.肝硬化结节的抵达时间、增强时间及开始消退时间均明显长于小肝癌(P<0.01),而其峰值强度和增强斜率均明显低于小肝癌(P<0.01).影响诊断准确率的因素包括:病灶位置、血流动力学、癌组织分化程度及病灶内血供.结论 超声造影技术可以较好地区分典型小肝癌与肝硬化结节,但造影结果受多种因素的影响,应结合造影定性与定量诊断结果进行综合分析.%Objective To explore the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of early liver cancer and discuss the factors influencing the diagnostic accuracy rate of CEUS. Method CEUS was applied for 215 patients (236 lesions) who were cirrhosis combined with small hepatic occupied lesion from May 2012 to May 2015. All the diameter of the lesions were less than 3 cm. Within 15 days after CEUS, all the patients were performed with needle biopsy and pathological diagnosis. Compared the CEUS diagnosis and pathological diagnosis, analyzed the differences of CEUS imaging characteristics and related parameters between benign nodules and malignant nodules, and discussed the influence factors of misdiagnosis and missed diagnosis. Result In the diagnosis of early liver cancer with CEUS, the sensitivity was 93.14%, the specificity was 95.52%, and the diagnostic accordance rate was 94.49%. The typical imaging characteristic of small hepatocellular carcinoma (SHCC) was "fast in and fast out". Most of cirrhotic nodule showed synchronous development between the lesions and adjacent liver tissue in the portal phase and substantial phase. The arrive time, enhancing lasting time and leaving time of cirrhotic nodule were all obviously higher than those results of SHCC (P < 0.01). The peaking intensity and enhancing slope of cirrhotic nodule were all obviously less than those results of SHCC (P < 0.01). The lesion location, hemodynamic, cancerous tissue differentiation degree and the blood supply in lesion were the factors which affected the diagnosis accuracy rate. Conclusion CEUS shows its advantage of distinguishing between the typical SHCC and liver cirrhosis nodules. But its imaging result are affected by many factors and the CEUS diagnosis should be combined with qualitative diagnosis and quantitative diagnosis.
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