超声造影测量肝脏动静脉渡越时间对肝病鉴别诊断的临床应用价值
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摘要
目的探讨实时灰阶超声造影测定肝动脉到达时间和肝静脉到达时间的方法及超声造影测量肝脏动静脉渡越时间对肝病鉴别诊断的临床应用价值。
方法70例肝病患者(肝硬化组20例、转移性肝癌组4例、原发性肝细胞癌非肝硬化亚组10例、原发性肝细胞癌肝硬化亚组18例和肝良性病灶组18例)和正常对照组15例接受低声压实时灰阶超声造影检查,经肘静脉团注入0.6ml SonoVue造影剂后,观察肝动脉和肝静脉的显影过程,记录肝动脉到达时间和肝静脉到达时间,并计算肝动静脉渡越时间(肝静脉到达时间与肝动脉到达时间之差)。15例正常对照者肝动脉到达时间和肝静脉到达时间分别用实时灰阶超声造影目测法和时间-强度曲线分析方法测定,对结果进行比较和相关性分析。各组肝动脉到达时间、肝静脉到达时间和肝动静脉渡越时间测值结果进行统计学分析。
结果实时灰阶超声造影目测法和时间-强度曲线分析方法测定肝动脉到达时间和肝静脉到达时间测值比较无显著性差异(P>0.05),两种检测方法测值存在正相关性(r=0.926、P=0.000和r=0.918、P=0.000)。各组肝动脉到达时间比较无显著性差异(P>0.05)。肝硬化组、转移性肝癌组、原发性肝细胞癌非肝硬化亚组及原发性肝细胞癌肝硬化亚组的肝静脉到达时间较正常对照组和肝良性病灶组明显提前(P<0.01),肝硬化组、转移性肝癌组、原发性肝细胞癌非肝硬化亚组及原发性肝细胞癌肝硬化亚组的肝动静脉渡越时间较正常对照组和肝良性病灶组明显缩短(P<0.01)。肝硬化组、转移性肝癌组、原发性肝细胞癌非肝硬化亚组及原发性肝细胞癌肝硬化亚组的肝静脉到达时间和肝动静脉渡越时间两两比较无显著性差异(P>0.05),正常对照组与肝良性病灶组肝静脉到达时间和肝动静脉渡越时间比较无显著性差异(P>0.05)。
结论实时灰阶超声造影目测法和时间-强度曲线分析方法测定肝动脉到达时间和肝静脉到达时间测值无显著性差异,两种检测方法测值存在正相关性。实时灰阶超声造影测量肝动静脉渡越时间能反映肝病肝内血流动力学的改变,对肝硬化超声定性诊断和肝良恶性肿瘤超声鉴别诊断具有一定的临床应用价值。
Objective To compare the different methods measuring hepatic artery arriving time (HAAT) and hepatic vein arriving time (HVAT) by real time gray scale contrast ultrasonography,and explore the clinical value of the hepatic artery to hepatic vein transit time (HAVTT) for diagnosis liver disease with contrast enhanced ultrasound.
Methods Seventy liver diseases patients(including 20 liver cirrhosis, 4 liver metastases,10 non-cirrhotic hepatic cell carcinoma,18 cirrhotic hepatic cell carcinoma,18 liver benign lesion)and 15 healthy volunteers in control group underwent real time gray scale contrast ultrasonography by vein rapid injection 0.6ml SonoVue,HAAT and HVAT were recorded,and HAVTT was calculated as the difference between HVAT and HAAT.HAAT and HVAT of 15 healthy volunteers were measured respectively by directly visualization of real time gray scale contrast ultrasonography and time-intensity cure analysis method,the results were compared to analyze the relativity.HAAT、HVAT and HAVTT of all case were analyzed after contrast enhanced ultrasound.
Results The results of HAAT and HVAT measured by these two methods were no significant difference(P>0.05),and there was positive correlation between these two methods(r=0.926、P=0.000 and r=0.918、P=0.000).No significant difference was found in HAAT among each group(P>0.05).HVAT in liver cirrhosis group,liver metastases group,non-cirrhotic hepatic cell carcinoma group and cirrhotic hepatic cell carcinoma group were significantly earlier than those in liver benign lesion group and healthy group(P<0.01),and HAVTT in liver cirrhosis group,liver metastases group,non-cirrhotic hepatic cell carcinoma group and cirrhotic hepatic cell carcinoma group were significantly shorter than those in liver benign lesion group and healthy group(P<0.01).HVAT and HAVTT in liver cirrhosis group,liver metastases group,non-cirrhotic hepatic cell carcinoma group and cirrhotic hepatic cell carcinoma group were no significant difference(P>0.05),there were no significant difference in HVAT and HAVTT between liver benign lesion group and healthy group(P>0.05).
Conclusions The results of HAAT and HVAT measured by directly visualization of real time gray scale contrast ultrasonography and time-intensity cure analysis method were no significant difference,there was positive correlation in results measured by these two methods.HAVTT can reflect hepatic homodynamic changes of liver diseases and have clinic value in diagnosis liver cirrhosis,benign liver tumor and malignant liver tumor by real time gray scale contrast ultrasonography.
方法70例肝病患者(肝硬化组20例、转移性肝癌组4例、原发性肝细胞癌非肝硬化亚组10例、原发性肝细胞癌肝硬化亚组18例和肝良性病灶组18例)和正常对照组15例接受低声压实时灰阶超声造影检查,经肘静脉团注入0.6ml SonoVue造影剂后,观察肝动脉和肝静脉的显影过程,记录肝动脉到达时间和肝静脉到达时间,并计算肝动静脉渡越时间(肝静脉到达时间与肝动脉到达时间之差)。15例正常对照者肝动脉到达时间和肝静脉到达时间分别用实时灰阶超声造影目测法和时间-强度曲线分析方法测定,对结果进行比较和相关性分析。各组肝动脉到达时间、肝静脉到达时间和肝动静脉渡越时间测值结果进行统计学分析。
结果实时灰阶超声造影目测法和时间-强度曲线分析方法测定肝动脉到达时间和肝静脉到达时间测值比较无显著性差异(P>0.05),两种检测方法测值存在正相关性(r=0.926、P=0.000和r=0.918、P=0.000)。各组肝动脉到达时间比较无显著性差异(P>0.05)。肝硬化组、转移性肝癌组、原发性肝细胞癌非肝硬化亚组及原发性肝细胞癌肝硬化亚组的肝静脉到达时间较正常对照组和肝良性病灶组明显提前(P<0.01),肝硬化组、转移性肝癌组、原发性肝细胞癌非肝硬化亚组及原发性肝细胞癌肝硬化亚组的肝动静脉渡越时间较正常对照组和肝良性病灶组明显缩短(P<0.01)。肝硬化组、转移性肝癌组、原发性肝细胞癌非肝硬化亚组及原发性肝细胞癌肝硬化亚组的肝静脉到达时间和肝动静脉渡越时间两两比较无显著性差异(P>0.05),正常对照组与肝良性病灶组肝静脉到达时间和肝动静脉渡越时间比较无显著性差异(P>0.05)。
结论实时灰阶超声造影目测法和时间-强度曲线分析方法测定肝动脉到达时间和肝静脉到达时间测值无显著性差异,两种检测方法测值存在正相关性。实时灰阶超声造影测量肝动静脉渡越时间能反映肝病肝内血流动力学的改变,对肝硬化超声定性诊断和肝良恶性肿瘤超声鉴别诊断具有一定的临床应用价值。
Objective To compare the different methods measuring hepatic artery arriving time (HAAT) and hepatic vein arriving time (HVAT) by real time gray scale contrast ultrasonography,and explore the clinical value of the hepatic artery to hepatic vein transit time (HAVTT) for diagnosis liver disease with contrast enhanced ultrasound.
Methods Seventy liver diseases patients(including 20 liver cirrhosis, 4 liver metastases,10 non-cirrhotic hepatic cell carcinoma,18 cirrhotic hepatic cell carcinoma,18 liver benign lesion)and 15 healthy volunteers in control group underwent real time gray scale contrast ultrasonography by vein rapid injection 0.6ml SonoVue,HAAT and HVAT were recorded,and HAVTT was calculated as the difference between HVAT and HAAT.HAAT and HVAT of 15 healthy volunteers were measured respectively by directly visualization of real time gray scale contrast ultrasonography and time-intensity cure analysis method,the results were compared to analyze the relativity.HAAT、HVAT and HAVTT of all case were analyzed after contrast enhanced ultrasound.
Results The results of HAAT and HVAT measured by these two methods were no significant difference(P>0.05),and there was positive correlation between these two methods(r=0.926、P=0.000 and r=0.918、P=0.000).No significant difference was found in HAAT among each group(P>0.05).HVAT in liver cirrhosis group,liver metastases group,non-cirrhotic hepatic cell carcinoma group and cirrhotic hepatic cell carcinoma group were significantly earlier than those in liver benign lesion group and healthy group(P<0.01),and HAVTT in liver cirrhosis group,liver metastases group,non-cirrhotic hepatic cell carcinoma group and cirrhotic hepatic cell carcinoma group were significantly shorter than those in liver benign lesion group and healthy group(P<0.01).HVAT and HAVTT in liver cirrhosis group,liver metastases group,non-cirrhotic hepatic cell carcinoma group and cirrhotic hepatic cell carcinoma group were no significant difference(P>0.05),there were no significant difference in HVAT and HAVTT between liver benign lesion group and healthy group(P>0.05).
Conclusions The results of HAAT and HVAT measured by directly visualization of real time gray scale contrast ultrasonography and time-intensity cure analysis method were no significant difference,there was positive correlation in results measured by these two methods.HAVTT can reflect hepatic homodynamic changes of liver diseases and have clinic value in diagnosis liver cirrhosis,benign liver tumor and malignant liver tumor by real time gray scale contrast ultrasonography.
引文
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17 Blomley MJ,Lim AK,Harvey CJ, et al.Liver microbubble transit time compared with histology and Child-Pugh score in diffuse liver disease:a cross sectional study.Gut,2003,52:1188-1193.
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27 Bernatik T,Becker D,Neureiter D, et al.Hepatic transit time of an echo enhancer:an indicator of metastatic spread to the liver.Eur Gastroenterol Hepatol,2004,16:313-317.
28 李安华,周建华,裴小青,等.声学造影对肝动-静脉渡赿时间临床意义的初步研究.中国超声医学杂志,2005,21:601-603.
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2 Quaia E,Bertolotto M,Forgacs B, et al.Detection of liver metastases by pulse inversion harmonic imaging during Levovist late phase:comparison with conventional ultrasound and helical CT in 160 patients.Eur Radiol,2003,13:475-483.
3 姚光弼,主编.临床肝脏病学.上海:上海科学技术出版社,2004.
4 田蓉,段云友,程颜苓,等.原发性和转移性肝癌肿块及肝脏的血流动力变化.第四军医大学学报,2001,22:932-936.
5 Albrecht T,Blomley MJ,Cosgrove DO,et al.Non-invasive diagnosis of hepatic cirrhosis by transit time analysis of an ultrasound contrast agent.Lancet,1999,353:1579-1583.
6 Blomley MJ,Albrecht T,Cosgrove DO,et al.Liver vascular transit time analyzed with dynamic hepatic venography with bolus injections of an US contrast agent:early experience in seven patients with metastases.Radiology,1998,209:862-866.
7 李安华,周建华,裴小青,等.声学造影对肝动-静脉渡赿时间临床意义的初步研究.中国超声医学杂志,2005,21:601-603.
8 叶任高,主编.内科学.第 5 版,北京:人民卫生出版社,2000.
9 Gramiak R,Shah PM.Echocardiography of the arotic root.Invest Radiol,1968,3:356-388.
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