超声造影在肝局灶性病变诊疗中的应用进展

doi:10.16150/j.1671-2870.2022.06.004

摘要/Abstract

摘要：

超声检查被多国肝病指南推荐作为肝脏肿瘤早期筛查监测手段。基于常规超声的超声造影（contrast-en-hanced ultrasound，CEUS）可以提供组织微循环灌注等方面的功能学相关信息，且较增强CT/MRI而言，具有实时、连续、动态、无放射性损伤等优势，其所用超声对比剂微泡经肺排泄，无心肾甲状腺毒性，适用于肾功能不全患者，过敏反应发生率极低。CEUS被多项国内和国际指南推荐作为诊断及鉴别肝脏局灶性病变（focal liver lesion，FLL）的一线增强影像学检查方式。相较于常规超声，CEUS可大幅度提高FLL病灶检出率和诊断及鉴别诊断能力。美国放射学院（American College of Radiology，ACR）发布的超声造影肝脏影像报告及数据系统（Liver Imaging Reporting And Data System，LI-RADS）可用于高危人群肝内病变全谱的描述及FLL危险程度分层和临床处理策略的推荐。在介入方面，CEUS有助于优化FLL穿刺活检路径和靶目标识别，提高穿刺成功率和标本阳性率，并应用于消融术中引导、即刻评估、长期疗效评估和术后随访等。除此之外，外科手术中应用CEUS检查可提高微小肝转移灶及化疗后常规影像显示消失的肝转移灶的检出率，从而帮助临床医师修订手术方案。CEUS对于肝脏恶性肿瘤患者全身系统治疗后疗的效评估也有一定的价值。

关键词: 肝局灶性病变, 超声造影, 肝细胞癌, 介入诊疗

Abstract:

Ultrasonography is recommended as an ideal imaging technique for surveillance and screening of liver tumors by guidelines in many countries. Contrast-enhanced ultrasound (CEUS) based on conventional ultrasound can provide function information of tissue microcirculation and perfusion.CEUS has advantages over contrast-enhanced CT/MRI in providing real-time, continuous, dynamic monitoring without radiation damage. The ultrasound contrast microbubbles is excreted through the lung,with no evidence of any effect on cardiac, renal and thyroid function. Contrast microbubbles can be applied to patients with renal insufficiency. There is a very low incidence of allergic reaction about ultrasound contrast agents. CEUS has been recommended as a first-line enhanced imaging technique for the diagnosis and differential diagnosis of focal liver lesions by domestic and international guidelines. Compared with conventional ultrasound, CEUS has better performance in detection,diagnosis and differential diagnosis of focal liver lesions(FLL). The contrast-enhanced ultrasound liver imaging reporting and data system (LI-RADS) issued by the American College of Radiology (ACR) is used to describe the full spectrum of intrahepatic lesions in high-risk patients, predicte the risk stratification of focal liver lesions, and recommend clinical management strategies. CEUS LI-RADS aimed to achieve an extremely high (ideally 100 %) positive predictive value for the diagnosis of hepatocellular carcinoma. CEUS LI-RADS is also applicable to the Chinese population. In the aspect of intervention, CEUS is helpful to optimizing of the path and identification of target in puncture biopsy of FLL, improving the success rate of puncture and positive rate of specimen, and is applied in the guidance during ablation surgery, instant assessment, long-term efficacy evaluation and postoperative follow-up. In addition, intraoperative application of CEUS can improve the detection rate of small liver metastases and identify disappearing liver metastases carcinoma after chemotherapy on regular images, thus helping clinicians to revise surgical protocols. CEUS also has certain application value in evaluating the efficacy of systemic treatment of liver malignancies. In conclusion, CEUS is playing an increasingly important role in the diagnosis and treatment of liver tumors

Key words: Focal liver lesion, Contrast-enhanced ultrasound, Hepatocellular carcinoma, Interventional therapy

中图分类号:

R715.2

任新平, 李军建, 张杰, 詹维伟. 超声造影在肝局灶性病变诊疗中的应用进展[J]. 诊断学理论与实践, 2022, 21(06): 684-690.

REN Xinping, LI Junjian, ZHANG Jie, ZHAN Weiwei. Advances in the application of contrast-enhanced ultrasound in the diagnosis and treatment of focal liver lesions[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(06): 684-690.

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