HBV相关肝硬化结节多模态超声诊断价值.docVIP

HBV相关肝硬化结节多模态超声诊断价值 　　[摘要] 目的 采用多模?B超声对HBV相关肝硬化背景内结节进行评估并分类。 方法 选取 2013年10月～2016年10月于浙江中医药大学附属杭州市西溪医院就诊的HBV相关性肝硬化患者200例，其中病理诊断为增生结节（RN）者51例，不典型增生结节（DN）者57例，其中低级别不典型增生结节（LGDN）27例，高级别不典型增生结节（HGDN）30例，肝细胞肝癌（HCC）为17例，均行多模态二维超声、彩色多普勒、超声造影检查，对比不同病理类型的结节多模态超声特征性表现，进一步将肝硬化背景肝内结节分为 Ⅰ、Ⅱ、Ⅲ、Ⅳ 4类。采用χ2检验比较不同大小、超声造影不同增强模式肝硬化背景肝内DN及HCC检出率的差异。 结果 直径2.0～3.0 cm结节 25个，均为 HCC与DN；直径1.0～2.0 cm 结节 94个，4个为HCC，24个 为 HGDN；直径1.0 cm结节6个 ，全部为RN ；不同大小肝硬化背景肝内结节HCC与DN检出率差异有统计学意义（P0.05）。RN结节主要以“等进等出”增强模式为主，LGDN主要以“慢进等出”增强模式为主，HGDN及HCC主要以“快进快出”增强模式为主，不同组间不同的增强模式差异有统计学意义（P0.05）；而HCC与HGDN在造影剂进入时间、达峰时间、流出时间上差异有统计学意义（P0.05 ），Ⅲ类、Ⅳ类结节在DN及HCC检出率上差异有统计学意义（P0.05 ）。 结论 多模态超声对于HBV相关肝硬化肝内结节进行评估、分类，对于HGDN及HCC早期诊断有一定帮助 。 　　[关键词] 多模态超声；超声造影；肝内不典型增生结节；肝肿瘤 　　[中图分类号] R735.7；R512.62；R445.2 [文献标识码] B [文章编号] 1673-9701（2017）33-0095-04 　　[Abstract] Objective To evaluate and classify nodules in HBV-related liver cirrhosis using multimodal ultrasound. Methods A total of 200 patients with HBV-related cirrhosis admitted in Xixi Hospital Affiliated to Zhejiang University of Chinese Medicine from October 2013 to October 2016 were enrolled. Among them， there were 51 cases pathologically diagnosed with nodular hyperplasia （RN）， 57 cases of atypical hyperplasia （DN）， including 27 cases of low grade atypical hyperplasia （LGDN）， 30 cases of high grade dysplastic nodules （HGDN） and 17 cases of hepatocellular carcinoma （HCC）.Two-dimensional ultrasound， color Doppler， contrast-enhanced ultrasound were used to compare the multimodal ultrasound characteristic manifestation of different pathological types of nodules. The liver cirrhosis nodules were further divided into four groups（Ⅰ，Ⅱ，Ⅲ and Ⅳ）. The chi-square test was used to compare the detection rates of intrahepatic DN and HCC？In the backgrounds of liver cirrhosis with different intensities of contrast-enhanced ultrasound and different sizes. Results There were 25 nodules with diameter ranged from 2.0 cm to 3.0 cm， all of which were HCCs and DNs. There were 94 nodules of 1.0-2.0 c