116 ( 3. 0 cm), 146 ( 3. 0 cm) 42 48 ; 48, 5 CT 38 (79. 2 %),, ;6 ;4 3 1. 5 cm, 1 2. 2 cm 27 (56. 0 %) ; 14 (29. 0 %) 2 4,17 1 2, 4, 42, 87. 5 %(42/ 48 ), ; CT, ; ; ; Early diagnosis of small hepatocellular carcinoma in patients with cirrhosis using contrast 2 enhanced ultrasound CH EN M in2hua, DA I Ying, YA N Kun, YA N G Wei, W U Wei, L I J i2you, Z HA N G X iao2peng, Y I N S han2shan. Department of Ult rasound, School of Oncology, Peking Universit y, Bei j ing 100036, China Abstract Objective To investigate the perfusion and contrast enhancement patterns of small hepatocellular carcinoma ( HCC) in cirrhotic livers for the role of contrast2enhanced ultrasonography ( CEUS) in diagnosing small HCC in size less than 3 cm with different histological types. Methods One hundred and forty2six patient s with focal liver lesions were referred to CEUS. Forty2eight small lesions in 42 patient s were diagnosed pathologically as HCC by surgery or needle biopsy. A diagnostic score of 1 to 5 was given to each lesion before and after contrast injection. Contrast2enhanced CT was performed in all the cases within 15 days of CEUS. Re sults Following contrast administration, 38 ( 79. 2 %) moderately to poorly differentiated HCC lesions presented with fast early arterial phase enhancement and then a quick wash2out in the parenchymal phase. Six well2differentiated HCC lesions had a contrast2enhancement pattern of fast2in and slow2out. Three of 4 clear cell carcinomas with the size of 1. 5 cm had an enhancement pattern of slow2in and slow2out. Another clear cell carcinomas of 2. 2 cm in size showed fast2in and fast2out pattern. Before CEUS, only 27 lesions ( 56. 0 %) were definitely or tentatively diagnosed as malignant lesions. After CEUS,the diagnostic scores of 14 HCC lesions (29. 0 %) were increased 224 point s,while 17 lesions increased 1 point s. Forty2two lesions were correctly diagnosed as malignant, while 2 lesions could not be diagnosed as benign or malignant and 4 lesions were diagnosed as malignant tentatively. The diagnostic accuracy of CEUS was 87. 5 % ( 42/ 48 lesions ). Conclusions The contrast enhancement patterns of small HCC with different histological types in CEUS were usef ul for early diagnosis of small malignancies. CEUS might be an alternative method to other imaging techniques, such as CT to diagnose small HCC in cirrhotic patient s. Key words Ultrasonography ;Contrast media ;Liver neoplasms ;Liver cirrhosis,, : ( ZD199909) :100036, [1,2 ] ; CT ( CT) MRI, 1 cm [1,3 ] [429 ], 转载

117, 2002 2004 146, ( 3 cm) 42 48, 38, 4 ; 35 81, (58. 4 12. 8) 0. 8 1. 0 cm 1,1. 1 1. 5 cm 8,1. 6 2. 0 cm 16,2. 1 3. 0 cm 23, (2. 34 0. 73) cm 16 (38. 1 %), 9 > 400 ng/ ml 42, CT, 2 10 2 20 Bracco SonoVue, (SF6 ), 2. 5 m, p H 4. 5 7. 5 5 ml, 2. 4 ml ( 5 mg/ ml, SF6 12 mg/ ) 2 3 s Technos DU6 DU8 Cn TI CA 431/ CA430 E, 2. 5 5. 0 M Hz :,, ;, Cn TI,,, MI < 0. 05, ;, ;, 10 min 2 6 8 min, 1 3 3 10 ; 2, CT MRI ; ;, CT,, [10 ], ( ), ; 1, 2, 3, 4, 5 ; 2,, 18 G SPSS 10. 0, F, 2 Fisher CT, 44 ; S7 S8 3 3 < 2 cm, 1, 2 95. 5 %(42/ 44 ) 1 2 1 48 (s, gx s ) - 38 14. 14 5. 26 22. 14 7. 49 60. 00 45. 92 6 14. 83 3. 06 25. 00 9. 36 263. 67 152. 75 3 4 25. 67 8. 96 # 30. 33 9. 50 134. 67 67. 99 :, 3 F = 11. 065, P = 0. 00 ; # F = 2. 90, P = 0. 048 2 38 2 48,, 6,, 3 1,,,,

118,, ( 1) 81. 3 %(39/ 48 ), 38,1 2. 2 cm 6, ( 2) 13 21 s,,4 103 291 s, 2 380 s 495 s, 4,3 1. 5 cm, 21 38 s, 60 193 s,, ( 3) ;48 27 (56. 0 %) ; 14 (29. 0 %) 2 4,17 1,48 3 3 48 ( ) 1 2 3 4 5 0 5 16 19 8 0 0 2 4 42 4,2, 42 ; 3 cm 87. 5 % (42/ 48 ) 2 2,, 2 ; 2, 3, CT 2, 0. 8 1. 2 cm 1,45,, 2,,CT,A :, 2 cm ( ) B :, ( ) C : 11 s ( ), 32 s ( ), 2,69, 10,,AFP (6. 3 ng/ ml) A : ( ) B :, ( ), 426 s, ( ) C:495 s ( ), 3,59, 15, A : 1. 3 cm ( ),, B :, 35 s ( ), 40 s C :60 s ( )

119,, 2 3 cm,,,,,, 1/ 5 [11 ], ; < 2 cm, Levovist SonoVue [4,12 ] SonoVue Cn TI,,,,,, 3, 80 %, [ 13 ], [5 ], [14 ], 3 2 35 38 s, 1 21 s, 3 4 5 s 2 cm 52. 1 %(25 ),,, 19,, ;25 21 (84. 0 %) ; 4 18 G CT [ 15 ],2 3, 0. 8 1. 2 cm,,,,, 2, ; ; ;,,,,,, 3. 0 cm, ; CT, 1 Quaia E,Degobbis F, Tona G,et al. Differential patterns of contrast enhancement in different focal liver lesions after injection of the microbubble US contrast agent SonoVue. Radiol Med,2004,107 : 1552165. 2 Suzuki Y,Fujimoto Y, Hosoki Y,et al. Clinical utility of sequential imaging of hepatocellular carcinoma by contrast2enhanced power

120 Doppler ultrasonography. Eur J Radiol,2003,48 :2142219. 3 de Ledinghen V,Laharie D,Lecesne R,et al. Detection of nodules in liver cirrhosis : spiral computed tomography or magnetic resonance imaging? A prospective study of 88 nodules in 34 patient s. Eur J Gastroenterol Hepatol,2002,14 :1592165. 4 Leen E, Angerson WJ, Yarmenitis S, et al. Multi2cent re clinical study evaluating the efficacy of SonoVue (BR1),a new ultrasound contrast agent in Doppler investigation of focal hepatic lesions. Eur J Radiol,2002,41 :2002206. 5,..,2004,13 :38242. 6,,,..,2004,20 :3262330. 7,,..,2000,15 :1702172. 8,,,..,2003,12 :1012104. 9,,,..,2003,12 :3512354. 10 Kim T,Murakami T, Takahashi S,et al. Optimal phases of dynamic CT for detecting hepatocellular carcinoma : evaluation of unenhanced and triple2phase images. Abdom Imag, 1999, 24 : 4732 480. 11,.. :,2002. 90294. 12 Yucel C, Ozdemir H, Gurel S, et al. Detection and differential diagnosis of hepatic masses using pulse inversion harmonic imaging during the liver2specific late phase of contrast enhancement with Levovist. J Clin Ultrasound,2002,30 :2032212. 13 Mat sui O, Kadoya M, Kameyama T, et al. Benign and malignant nodules in cirrhotic livers : distinction based on blood supply. Radiology,1991,178 :4932497. 14. -. :,1996. 28242. 15 Dalla2Palma L, Bertolotto M, Quaia E, et al. Detection of liver metastases with pulse inversion harmonic imaging : preliminary results. Eur Radiol,1999,9 ( Suppl 3) :S3822387. ( :2004209203) 1,30 1 1,, : ( + + ), ( + ) :,,, : 2. 5 cm 2. 5 cm,, ( 1) :,,RI 0. 38 :, : 3 cm 3 cm,,,,, :, 2, 2 % 4 % [1 ], 80 % 90 %,,,,,,, [2 ],,,, 1 :266003 1,.. :,2003. 2432245. 2..,2002,18 :1462147. ( :2004207205)