目的 研究超声造影增强能量多普勒鉴别诊断肝脏局灶性结节性增生（FNH）与肝细胞癌（HCC）的临床价值，为临床提供 参考。方法 选取 2020 年 1 月至 2021 年 12 月内江市第二人民医院收治的 80 例肝脏病变患者为研究对象进行回顾性分析，根据病变性质 的不同分为 FNH 组（38 例）和 HCC 组（42 例），比较两组患者超声造影定量参数 [ 达峰时间（TTP）、造影剂到达时间（AT）、造影剂 平均通过时间（MTT）及增强斜率（ES）] 和影像学特征表现。分析超声造影增强能量多普勒鉴别 FNH 与 HCC 的价值。结果 FNH 组患 者淋巴结肿大和肝硬化发生率低于 HCC 组，中心瘢痕发生率高于 HCC 组（P<0.05）。门脉期 FNH 组患者肝脏病变以等增强为主，HCC 组以低增强为主，延迟期两组患者均以低增强为主（P<0.05）。FNH 组患者抱球征和“车轮状”血流信号率高于 HCC 组，TTP 和 AT 显 著短于 HCC 组（均 P<0.05）。受试者操作特征（ROC）曲线分析结果显示，“车轮状”血流信号 [ 曲线下面积（AUC）=0.716，敏感度 =0.574，特异度 =0.845，P=0.020]、TTP（AUC=0.767，敏感度 =0.842，特异度 =0.714，P=0.004）及 AT（AUC=0.717，敏感度 =0.789， 特异度 =0.571，P=0.019）对鉴别 HCC 与 FNH 具有一定的应用价值。结论 超声造影增强能量多普勒检查有助于 HCC 与 FNH 的鉴别诊 断，其中“车轮状”血流信号、TTP 及 AT 诊断价值较高。
Objective To study the clinical value of contrast-enhanced ultrasound power doppler in differential diagnosis of focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC) of the liver, and provide reference for clinical practice. Methods 80 patients with liver diseases admitted to the Second People’s Hospital of Neijiang from January 2020 to December 2021 were selected for retrospective analysis. They were divided into FNH group (38 cases) and HCC group (42 cases) according to the nature of the lesions. The quantitative parameters of contrast-enhanced ultrasound [time to peak (TTP), arrival time (AT), mean transit time (MTT) and enhancement slope (ES)] and imaging characteristics of the two groups were compared. The value of contrast-enhanced ultrasound power doppler in differentiating FNH from HCC were analyzed. Results The incidence of lymphadenopathy and cirrhosis in FNH group were lower than that in HCC group, and the incidence of central scar in FNH group was higher than that in HCC group (P<0.05). Iso-enhancement was dominant in FNH group at portal pulse stage, hypoenhancement was dominant in HCC group, and hypoenhancement was dominant in both delayed stage groups. (P<0.05). The ball sign and “wheel like” blood ?ow signal rate in FNH group were higher than those in HCC group, and TTP and AT were signi?cantly shorter than those in HCC group (all P<0.05). The results of ROC curve analysis showed that the “wheel like” blood ?ow signals [area under the curve (AUC) =0.716, sensitivity=0.574, speci?city=0.845, P=0.020], TTP (AUC=0.767, sensitivity=0.842, speci?city=0.714, P=0.004) and AT (AUC=0.717, sensitivity=0.789, speci?city=0.571, P=0.019) had certain application value in differentiating HCC and FNH. Conclusion Contrast-enhanced ultrasound power doppler examination is helpful in the differential diagnosis of HCC and FNH, among which “wheel like” blood ?ow signal, TTP and AT have higher diagnostic value.