Clinical Application Of Real-time Contrast-enhanced Ultrasonography In Local Hepatic Lesion

Background and Objective: The local hepatic lesion was a familiar illness; it played a vital role to detect it and to identify it from malignant and benign pathological changes in the early stages. Hepatic ultrasonography was the first choice in the hepatic image detection and there were great clinic values to the early stage discovering of local pathological changes. But it was the simple diagnosis through sound-image graph for conventional two-dimensional ultrasonography that cannot get the information of the vas of tumour and the supply of blood -just the information of modality. Therefore, it might be one of the approaches of select detection for local pathological changes because of its limitation in diagnose. The application of color Doppler ultrasonography on the diagnosis of liver lesion provided valuable information for the identification and the diagnosis of liver tumor at the point of blood supply and blood dynamics. But it is insensitive for the slow blood flow, incapable of showing the tiny vas and subject to many factors like the angles of detection and the location of tumor etc. As the rapid development of the modern contrast agent and the technology of contrast-enhanced ultrasonography, this revolutionary development and the historical revolution for ultrasonography makes the converting from laboratory research of ultrasonic contrast technology to clinic application quickly. As the representative of the third generation modern ultrasonic contrast agent, SonoVue, under the approach of low mechanism-index, it should produce micro-bubble syntony without cracking; taking advantages of the nonlinearity effect produced by it and the select inception and acquiring the distribution of the bubble in the micro-circulation on the real-time, as well as showing the blood perfusion in the liver tumor on thereal-time distinctly, it should improve the qualitative diagnose of tumor through the characteristic of blood supply of different tumor by the showing of more blood flow and tiny vas in tumor. In addition, it may be helpful for the detecting of lesion, improving the sensitivity of the ultrasonography by the enhancing of image contrast between the liver tumor and the natural liver parenchyma through the using of ultrasonic contrast agent. Until now, Contrast-enhanced ultrasonography is a young field and the research of ultrasonic contrast is developing and in the stage of exploring in the clinic application, this dissertation is doing some valuable exploring in this field for the role played by using of SonoVue in real-time contrast-enhanced ultrasonography for the detecting of hepatic lesion.Methods: For 41 local hepatic lesion patients were examined by ultrasonography in our department from June 2004 to Feb 2005, 40 of them were chosen as the lesion example that having local hepatic lesion by conventional two-dimensional ultrasonography, including 18 hepatocellular carcinoma, 9 metastasis liver tumors, 10 hemangiomas and 3 cirrhotic nodule. The biggest diameter of these lesions was 15.6cm, the smallest was 1.2cm. As for the patients with multimode lesion, the lesions having the best image showing were selected. All the examples were authenticated by operations or pathology puncture, or confirmed by the combination of CT and clinic materials. Except for one example of lung cancer patient, there was only showing of increscent liver and unsymmetrical echo .by the conventional two-dimensional ultrasonography without obvious occupational lesion; the echo was not even obviously. But there were showing of multimode tumor in every part of liver to implicate the multimode metastasis of liver by the enhanced CT.For all the patients, the first step is to detect the liver by the using of conventional two-dimensional ultrasonography , recording the location, diameter, echo phenomenon of local lesion etc.; then the blood flow signals in the lesions or at the fringe of it were observed by switching on the color Doppler, and were measured by pulse Doppler; then the primary diagnoses were obtained before the contrast-enhanced ultrasonography. When contrast enhancing, 2.4 ml of SonoVue contrast agent was injected quickly through superficial vein of the elbow in 3-5 s, andthen rinsed by 5ml of physiological saline solution. When the rapid of injecting of contrast agent, the real-time contrast-enhanced ultrasonography state was launched simultaneously after the choice of optimal section for observation; then the dynamic injection transformation of lesion was observed continually on the real time that would be lasted for 5-7min, at the end the whole liver was detected rapidly in order to find the new lesion.Result: The enhanced showings of different kinds of lesion have different characteristics after ultrasonic contrast-enhanced ultrasonography: the displaying of the whole lesion of 18 hepatocellular carcinoma in artery were enhanced rapidly, then the echo was decreased rapidly in the 17 examples, which presented obvious lower-echo "lacking" area in the arterial phase too. 9metastatic liver tumors presented variously in the arterial phase and presented obvious lower-echo "lacking" area, and been detected more lesions than in conventional ultrasonography. 1 example which had no obvious local hepatic lesion under two-dimensional ultrasonography was found many lower-echo and verge-clearly lesions distributing all over the liver in the parenchymal phase after contrast-enhanced ultrasonography. 10 hemangiomas enhanced peripherally in the early phase and then filled centripetally; cirrhotic nodule was enhanced with the same style as liver parenchyma.The rate of diagnose confirmation for the lesion of benign tumor was 53.85%(7/13) by the conventional two-dimensional ultrasonography union color Doppler before the contrast-enhanced ultrasonography, that would be92.31%(12/13) after the contrast-enhanced ultrasonography, p<0.05; The rate of diagnose confirmation for the lesion of malignant tumor was 55.56%(15/27) before the contrast-enhanced ultrasonography and would be 96.30%(26/27) after the contrast-enhanced ultrasonography, p<0.05, there were distinct difference for the diagnose results between the former and the later.Conclusion: The real-time contrast-enhanced ultrasonography should improve the qualitative diagnosis for the local hepatic lesion, should be helpful for the identification of the malignant tumor and benign tumor; and it should improve the detection of local lesion also.