Focal Liver Lesions Ultrasound Contrast Time - Relative Intensity Curve Analysis And Imaging In Patients With Tongue Like Characteristics Of,

Objective:59 focal liver lesions (FLL) were examed by contrast enhanced ultrasound (CEUS) with pulse-inversion harmonic imaging and SonoVue contrast agent. To draw time-intensity curve(TIC) and time-relative -intensity curve (TRIC) with QLAB software and EXCEL software. Firstly, to observe the enhancement patterns of FLL. Secondly, to compare the types of TIC and acoustic quantified parameters of CEUS. Thirdly,to investigate the types of TRIC with CEUS in diagnosing FLL, and to investigate the diagnosis value of TRIC in differentiating benign and malignant focal liver lesions. Fourthly, to analyse the tongue features of patients.Methods:59 FLL were examed by CEUS with Philips iU22 machine, pulse-inversion harmonic imaging and SonoVue contrast agent. Firstly, gray-scale sonography was used to observe the quantity, position, size, echo characterization and color Doppler flow imaging of FLL. Then transformed the sequences to the state of CEUS after the best section was selected.CEUS PIH examinations were set to a low mechanical index of 0.06. Side/side pattern was used, the left side of the monitor was pulse-inversion harmonic imaging pattern,while the anatomic structure can be observd on the right side. A 2.4 ml intravenous bolus injection of SonoVue was used, and followed by a flush of 5ml of salin.At the same time, begin timing and recording the dynamic image,observing the enhancement patterns. Then to draw TIC of lesion and liver with QLAB software, acquiring the acoustic quantified parameters. The echo intensity of lesion minused the echo intensity of liver equaled relative intensity, to draw and type TRIC with EXCEL software. Observe tongue feature of the patients with FLL.Results: 1. Homogeneous and inhomogeneous enhancement patterns appeared mostly in primary liver carcinoma (PLC) and metastasis liver carcinoma (MLC). Centripetal enhancement pattern existed mostly in hepatic hemangioma (HH). Centrifugal enhancement pattern appeared in focal nodular hyperplasia (FNH). Focal fatty sparing (FFS) and hepatic cirrhosis regenerative nodule (HCRN) showed equal enhancement in liver.2. TIC appeared quick-ascending and quick-descending types in the malignant lesions, but slow-ascending and slow-descending types in the benign lesions.3. The acoustic quantified parameters including peak time and enhancement time in the malignant lesions were significantly earlier than those in the benign lesions (P<0.001). The ascending slope in the malignant les ions was quicker than those in the benign les ions (P<0.01). The descending slope in the malignant lesions were significantly quicker than those in the benign lesions (P<0.001).4. The most common TRIC of malignant lesions was typeⅢ, while the TRIC of begin lesions showed typeⅠand typeⅡ. TRIC appeared quick-ascending and quick-descending types in the malignant lesions, and decline curve drop down to 0 dB at (28.24±8.14) s on average, then continue droping down to-8 dB.While TRIC appeared slow-ascending and slow-descending types in the benign lesions, and decline curve drop down to the lowest 4 dB.5. The tongue of patients with malignant lesions of ten showed yellow and coated tongue. Also teeth-marked tongue and enlarged tongue often appeared to patients with malignant lesions.Conclusion:1. CEUS can improve the echo difference between the lesion and the liver,the enhancement patterns of FLL can increase the diagnosis rate.2. The type of TIC, acoustic quantified parameters of CEUS are valuable to the clinical diagnosis in benign and malignant focal liver lesions.3. TRIC reflect the different echo of lesion and liver, the types of TRIC are different in FLL.4. According to the different type of TRIC descending slope, we can differentiate the benign and malignant lesions. Enhancement pattern provide blood supplying information of FLL. TRIC with enhancement pattern is valuable to clinical diagnosis in FLL.5. The tongue of patients with malignant lesions often showed yellow and coated tongue, teeth-marked tongue and enlarged tongue. The tongue features had clinical value in distinguishing patients with malignant and begin lesions.