Application value of contrast-enhanced ultrasound in the diagnosis of hepatic capsule tuberculosis

Abstract

Objective To investigate the characteristics of contrast-enhanced ultrasound in hepatic capsule tuberculosis. Methods Forty-eight hepatic capsule tuberculosis patients who proved by ultrasound-guided needle biopsy or surgical pathology from Hangzhou Red Cross Hospital from Dec 2008 to Oct 2015 were retrospective analyzed. Totally 71 lesions of 48 hepatic capsule tuberculosis patients were examined by both routine and contrast-enhanced ultrasound to analyze their characteristics of location, shape, size, echo and enhanced phase, intensity and mode etc. Results Hepatic capsule tuberculosis was commonly displayed on hepatic diaphragmatic surface capsule (54/71, 76.1%) with fusiform shape (59/71, 83.1%) and hybrid echo (48/71, 67.6%) mostly. Hepatic capsule tuberculosis was divided into two types based on the relations between lesion and hepatic capsule. Type Ⅰ was performed to be the integrated continuity of hepatic capsule at the boundary of lesion and liver (37/71, 52.1%). Type Ⅱ was performed to be interrupted continuity of hepatic capsule at the boundary of lesion and liver (Type Ⅱa, 20 cases, 28.2%) or disappearance (TypeⅡb, 14 cases, 19.7%). Sixty-three lesions (88.7%) were performed to be hyper-enhanced in arterial phase by contrast-enhanced ultrasound. The average starting time of enhancement was (12.5±2.2) s (range 9-17 s). The average peak time was (28.4±3.8) s (range 22-35 s). Lesions in portal phase and delay phase were showed mid-enhanced or low-enhanced, and 8 cases (11.3%) were showed non-enhanced by contrast-enhanced ultrasound all the time. Lesion echo could be divided into 4 performances according to peak intensity: non-enhancement (8 cases, 11.3%), annular enhancement (29 cases, 40.8%), nonhomogeneous enhancement (24 cases, 33.8%) and homogeneous enhancement (10 cases, 14.1%). Differences between different results of hepatic capsule tuberculosis by contrast-enhanced ultrasound were significantly statistical (P<0.01). Conclusions Hepatic capsule tuberculosis is mostly performed to be annular enhancement and nonhomogeneous enhancement by contrast-enhanced ultrasound. Contrast-enhanced ultrasound can show the blood perfusion of hepatic capsule tuberculosis, which has important reference value in such diagnosis. Key words: Liver diseases; Tuberculosis; Ultrasonography; Contrast media