论文标题:肝转移癌超声造影临床应用研究
论文作者
论文导师 康春松,论文学位 硕士,论文专业 影像医学与核医学
论文单位 山西医科大学,点击次数 95,论文页数 31页File Size2261K
2006-05-26论文网 http://www.lw23.com/lunwen_891239412/
Ultrasonography; Contrast media; Liver neoplasms; Neoplasm metastasis
目的：探讨超声造影对肝转移癌病灶的检出能力；探讨肝转移癌超声造影增强时相特点及回声变化规律；结合QontraXt定量分析软件，定量评价肝转移癌的血流动力学特点。 方法：35例经增强CT检查、原发病灶及转移灶手术病理检查或内窥镜活检、肝穿刺活检病理检查并经3个月以上随访，患者一般情况进行性恶化或死亡符合恶性肿瘤确诊肝转移癌为研究对象，应用实时超声造影匹配成像技术(CnTI)与超声造影剂声诺维(SonoVue)对其行造影超声检查。动态观察肝转移癌注射造影剂后在动脉相(0～40s)、门脉相(41～120s)及实质相(120s以后)灌注和回声变化规律。记录病灶大小、位置、数目、各增强时相的表现。用QontraXt定量分析软件，对76个肝转移癌进行量化分析，自动生成伽马拟合时间—强度曲线，提供以下定量指标：Peak：灌注峰值，TP：达灌注峰值的时间，Sharpness：曲线的尖度，AUC：曲线下面积。分析评价以上指标在肝转移癌超声造影诊断中的意义。 结果：(1)．35例肝转移癌常规超声共检出病灶182个，最大病灶直径7.1cm，最小0.8cm，超声造影共检出病灶386个，最大7.1cm，最小0.5cm。超声造影较常规超声多检出新病灶204个，直径均在3cm以下，差异有统计学显著性(P＜0.05)，其中小于1.0cm的病灶85个，占41.7％，(P＜0.01)；1.0～2.0cm(不包括2.0cm)的病灶91个，占44.6％(P＜0.01)；2.0～3.0cm(不包括3.0cm)的病灶28个，占13.7％。(2)．肝转移癌动脉相表现四种灌注特征：Ⅰ型：病灶周边环状增强，中心不增强或有少量点状、短线状(长度小于病灶半径)血管向中心伸延；Ⅱ型：病灶周边环状增强，内部少量均匀增强；Ⅲ型：病灶周边环状增强，内部少量增强，可见细长分枝状(长度大于病灶半径)血管；Ⅳ型：病灶快速整体团状增强，内部团状或网状走行血管。35例76个病灶中，表现为Ⅰ型的共10例20个病灶，Ⅱ型共18例35个病灶，Ⅲ型共6例9个病灶，Ⅳ型共7例12个病灶。(3)．对四种增强类型行定量分析，峰值强度Ⅰ型明显低于其他三型，Ⅳ型明显高于其他三型，差异有统计学显著性(P＜0.05)；达峰时间Ⅳ型明显短于其他三型，差异有统计学显著性(P＜0.05)；曲线下面积(AUC)Ⅳ型明显高于其他三型，差异有统计学显著性(P＜0.05)。(4)．35例76个病灶门脉相和实质相均呈现不同程度低回声，其中实质相共有22例54个病灶内部无造影剂进入或造影剂完全廓清接近于未注射造影剂时的水平，与相邻肝组织对比非常明显呈“黑洞”现象。 结论：1．实时超声造影提高了肝转移癌病灶与正常肝组织的对比，增加了肝转移癌病灶的检出数目；2．肝转移癌增强模式及造影表现有利于其性质的确定；3．对肝转移癌血流灌注的定量分析，有利于客观诊断，有利于解释各增强类型的形成基础。
Objectives: To evaluate capabilities of contrast-enhanced ultrasound with SonoVue in detection of liver metastases compared with conventional ultrasound. To investigate the perfusion and echogenicity of liver metastases using contrast tuned imaging and to analyse the hemodynamic parameters using QontraXt software.Methods: Thirty-five patients with known liver metastases were evaluated by conventional ultrasound and contrast tuned imaging(CnTI) gray scale ultrasound examination, respectively. The sizes, numbers of lesions found during CEUS were compared with those of conventional US. The perfusion patterns of liver metastases were evaluated. The enhancement type of the lesions were observed at arterial phase(0-40s), portal vein phase(41-120s) and late phase(after 120s). QontraXt software(AMID Italy) was used to estimate the following parameters: Peak(corresponging to blood volume of the lesion), Tp(time reaching maximum peak), Sharpness(corresponding to the velocity of perfusion and clearance of the lesion), AUC(corresponding to the blood flow of the lesion). These parameters were obtained from the time-intensity curves.Results: (l).In 35 patients, 182 liver metastases were found by US and the diameter of the largest lesion and the smallest lesion were 7.1cm and 0.8cm respectively; 386 liver metastases were found by CEUS and the diameter of the largest lesion and the smallest lesion were 7.1cm and 0.5cm, respectively. 204 more lesions were found by CEUS than by conventional US. The difference was statistically significant (P<0.05) . (2).During the arterial phase, the perfusion patterns of 76 major investigated lesions were in four types: 26.3%(20 lesions) enhanced in rim-like and the central region of the lesion was defected; 46.1%(35 lesions) enhanced in rim-like and the inside region of the lesion was homogeneous enhancement but was hypoechoic with respect to the surrounding liver; 11.8%(9 lesions) enhanced in rim-like and tortuous vessels were detected in the lesion; 15.8%(12 lesions) bolus-enhanced quickly and was hyperechonic compare to surrounding parenchyma. (3). A significant statistical difference (P<0.05 ) was found in the values of Peak, Tp, and AUC between the type of bolus-enhanced and other three types. The value of Peak of the type which central region of the lesion was defected was lower than that of other three types. The difference was statistically significant (P<0.05) . (4). In portal vein phase and late phase, all 76 lesions of 35 patients were hypoechoic in relation to the surrounding parenchyma. 54 lesions of 22 patients appear as completely defect in late phase.Conclusions: (1). CnTI markedly increase the contrast between the normal liver and the metastases and thus improve the detection. (2). To observe the enhancement patterns of liver metastases is helpful to characterization. (3). Quantitative analysis of the perfusion of liver metastases is helpful to diagnosis and could explain the reason of the enhancement patterns.
|
