探讨实时超声造影定量分析对体检初次发现肝脏局灶性病变的临床诊断价值。

选取2018年1月至2021年1月在海口市第四人民医院初次体检经普通彩色多普勒超声发现肝脏局灶性病变的87例患者行实时超声造影检查，以穿刺病理学诊断结果为标准，分析实时超声造影与普通彩色多普勒超声检查结果。采用时间-强度曲线（TIC）定量分析实时超声造影特征，比较不同病变性质超声造影特征。

87例患者共101个病灶，单发病灶74例，多发病灶13例。经病理检查证实良性病变47例57个病灶，其中结节性增生21例26个病灶，肝血管瘤9例9个病灶，肝硬化结节3例4个病灶，局部炎症病变4例4个病灶，局灶性脂肪缺损10例14个病灶。恶性病变40例44个病灶，其中原发性肝细胞癌16例18个病灶，转移性肝癌11例12个病灶，胆管细胞性肝癌13例14个病灶。体检彩色多普勒超声对47例57个病灶的诊断符合率为77.19%，实时超声造影对良性病变诊断符合率为100%，差异有统计学意义（χ²=12.503，P=0.01）。彩色多普勒超声对40例44个恶性病变诊断符合率为61.36%，实时超声造影诊断符合率为93.18%，差异有统计学意义（χ²=10.935，P=0.001）。良性病变患者TIC曲线始增时间、达峰时间及峰值减半时间均明显晚于恶性病变患者（P＜0.05）；良性病变组患者TIC曲线峰值强度明显低于恶性病变组（P＜0.05）。良性肝脏局灶性病变患者血流量化分级0级、Ⅰ级占比较高，而恶性肝脏局灶性病变患者血流量化分级Ⅲ级、Ⅱ级占比较高，2组比较差异具有统计学意义（P＜0.05）。

实时超声造影通过肝脏局灶性病变内部血流灌注、造影增强方式及TIC曲线参数可定量鉴别肝脏良恶性病变，可作为临床判定初次体检经彩色多普勒超声发现的肝脏局灶性病变的有效手段。

To assess the clinical diagnostic value of real-time contrast-enhanced ultrasound (CEUS) quantitative analysis in hepatic focal lesions initially discovered in physical examination.

Eighty-seven patients with hepatic focal lesions initially discovered by conventional color Doppler ultrasound in the physical examination at the Fourth People's Hospital of Haikou City from January 2018 to January 2021 were selected to undergo real-time CEUS examination. The results of real-time CEUS and conventional color Doppler ultrasound were analyzed based on the puncture pathology results. The time-intensity curve (TIC) was used to quantitatively analyze the real-time CEUS characteristics of the lesions and to compare the CEUS characteristics of different lesions.

A total of 101 lesions were detected in 87 patients, including 74 cases with a single lesion and 13 cases with multiple lesions. Pathological examination confirmed 57 lesions in 47 cases with benign lesions, including 21 cases of nodular hyperplasia (26 lesions), 9 cases of hepatic hemangioma (9 lesions), 3 cases of cirrhosis nodules (4 lesions), 4 cases of local inflammatory lesions (4 lesions), and 10 cases of focal fat defect (10 lesions). There were 40 cases (44 lesions) of malignant lesions, including 16 cases (18 lesions) of primary hepatocellular carcinoma, 11 cases (12 lesions) of metastatic liver cancer, and 13 cases (14 lesions) of cholangiocellular liver cancer. The diagnostic coincidence rate of color Doppler ultrasonography with the puncture pathology results for the 57 lesions in the 47 cases with benign lesions was 77.19%, and that of real-time CEUS for benign lesions was 100%; the difference was statistically significant between the two modalities (χ²=12.503, P=0.01). The diagnostic coincidence rate of color Doppler ultrasonography with puncture pathology results for the 44 malignant lesions was 61.36%, while that of real-time CEUS was 93.18%; the difference was statistically significant between the two modalities (χ²=10.935, P=0.001). The rise time, time to peak, and time to time to half value in the TIC curve were significantly later in patients with benign lesions than in those with malignant lesions (P＜0.05), while the peak intensity was significantly lower in patients with benign lesions than in those with malignant lesions (P＜0.05). The proportion of patients with blood flow Alder grade 0 and grade Ⅰ was higher in patients with benign hepatic focal lesions, while the proportion of patients with blood flow Alder grade Ⅱ and grade Ⅲ was higher in patients with malignant hepatic focal lesions; the differences between the two groups were statistically significant (P＜0.05).

Real-time CEUS can quantitatively identify benign and malignant liver lesions by assessing internal blood perfusion of hepatic focal lesions, contrast enhancement pattern, and TIC curve parameters, and can be used as an effective means for clinically determining the hepatic focal lesions detected by color Doppler ultrasound in physical examination.