于杰，于晓玲，梁萍，刘方义
（中国人民解放军总医院 介入超声科，北京 100853）

[摘  要] 目的 探讨灰阶超声造影在脾脏局灶性病变诊断中的应用价值。材料和方法 经外周静脉团注声诺维( SonoVue)，使用对比脉冲序列(CPS)技术，对56例脾脏局灶性病变患者共74个病灶行超声造影检查，分析造影剂灌注特征。结果 恶性肿瘤病灶20个，良性病灶54个，除包括微波消融后病灶、梗塞灶、囊肿、挫裂伤病灶和脓肿等共计34个病灶呈现造影无增强外，其余40个病灶均表现出不同程度的增强。20个恶性肿瘤中6个(30.0%)表现为动脉期高增强，19个(95.0%)表现为延迟期低增强，其中80.0%(8 /10个)的转移瘤病灶动脉期呈偏低增强，8个淋巴瘤病灶动脉早期呈现高增强和低增强者均为4个(50%)；20个增强的良性病灶中16个表现为动脉期等或高增强(80%),13个(65.0%)表现为延迟期等或高增强，其中76.9%(10/13个)血管瘤病灶表现为动脉期周边结节样高增强。与病理诊断比较，超声造影诊断的敏感性、特异性及准确性分别为96.8%、95.0%及96%，均高于常规超声诊断(分别为64.5%、89.5%及78.0%)。结论 实时超声造影对脾局灶性病变的诊断和鉴别诊断具有一定的应用价值。
[关键词] 超声造影；脾脏；局灶性病变；影像诊断
[中图分类号] R445.1;R657.6         [文献标志码] B
[文章编号] 1674-1633(2009)11-0005-05

YU Jie,YU Xiao-ling; LIANG Ping, LIU Fang-yi
(Department of Interventional Ultrasound, the PLA General Hospital, Beijing 100853,China)

Abstract: Objective To discuss the value of contrast-enhanced ultrasound (CEUS) in the splenic lesions. Materials and Methods Contrast-enhanced ultrasound with a blot injection of SonoVue was performed in 56 patients with 74 focal splenic lesions  (FSLs) and their perfusion characteristics were analyzed by using contrast pulse sequences(CPS) technique. Results Among 20 malignant lesions and 54 benign lesions, 34 lesions including 13 microwave ablation lesions, 4 splenic artery embolization lesions, 6 splenic infarctions, 8 splenic cysts, 2 splenic ruptures and 1 splenic abscess were demonstrated non-enhancement. Other 40 lesions were showed enhancement to different extent. 6(30.0%) of malignant lesions were hyper-enhancement in the arterial phase and 19(95.0%) hypo-enhancement in the late phase. For 10 metastases tumors，80.0%(8 /10个)were shown hypo-enhancement in the arterial phase and CEUS showed 4 hyper-enhancement and 4 hypo-enhancement for 8 lymphomaes in the arterial phase.Among 20 benign lesions with enhancement 16(80.0%) were shown iso-enhancement or hyper-enhancement in the arterial phase and 13(65.0%)lesions were iso-enhancement or hyper-enhancement in the late phase, for 13 hemangiomas, 10(76.9%) were shown strong inhomogeneous peripheral enhancement in the arterial phase. Compared to the pathological diagnosis, the sensitivity, specificity and accuracy of CEUS were 96.8% , 95.0% and 96%, higher than that of conventional ultrasound(64.5%、89.5%、78.0%). Conclusion Real-time contrast-enhanced ultrasound can provide useful information for the diagnosis and differential diagnosis of focal splenic diseases.
Key words: contrast-enhanced ultrasound; spleen; focal lesions; imaging diagnosis