探讨超声造影（CEUS）在肝硬化结节恶变筛查中的价值。

回顾性分析2012年1月至2016年12月中山大学附属第三医院行超声检查随访的25例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。患者均为男性；年龄33～82岁，中位年龄55岁；共29个肝硬化结节。所有患者均接受规律的超声检查随访，均接受常规超声和CEUS检查，记录结节的直径、内部血流信号、超声造影增强模式等。结节直径比较采用t检验，超声造影模式比较采用Fisher确切概率法，诊断试验采用受试者工作特征（ROC）曲线。

随访过程中，14个肝硬化结节恶变为肝细胞癌（肝癌）。发生恶变的结节直径（19±8）mm较恶变前(16±7) mm明显增大（t=2.682，P<0.05）。随着结节恶变，结节CEUS动脉期逐渐由等增强（12/14）转变为高增强(13/14)，门静脉期/延迟期由等增强（13/14）转变为低增强（13/14），差异有统计学意义（P<0.05）。AFP、常规超声、CEUS诊断肝硬化结节恶变的曲线下面积分别为0.607、0.679、1，差异有统计学意义（Z=4.837，6.904；P<0.05）。

在肝硬化结节的连续随访过程中，CEUS能早期发现恶变结节内部血流动力学变化，较常规超声具有更好的诊断价值。

To explore the value of contrast-enhanced ultrasonography (CEUS) in the screening of malignant transformation from cirrhotic nodules.

Clinical data of 25 patients who were followed up by ultrasonography in the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2016 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were males, aged 33-82 years old, with the median age of 55 years old, and with a total of 29 cirrhotic nodules. All patients were followed up regularly by ultrasonography which included conventional ultrasound and CEUS. The diameter, internal blood flow signal and CEUS features of the nodules were recorded. The diameter was compared by t test, and the CEUS features by Fisher's exact probability test. ROC curve was used for diagnostic test.

During the follow-up, 14 cirrhotic nodules turned into hepatocellular carcinoma (HCC). The diameter of malignant nodule (19±8) mm was significantly higher than (16±7) mm before malignant change (t=2.682, P<0.05). As the nodules transformed to malignancy, in the arterial phase of CEUS, signals changed gradually from equal enhancement (12/14) to hyper enhancement (13/14), and in the portal venous phase or delayed phase, it changed from equal enhancement (13/14) to low enhancement (13/14), where significant difference was observed (P<0.05). The area under the curve of AFP, conventional ultrasound and CEUS in diagnosing malignancy of cirrhotic nodules was 0.607, 0.679 and 1, respectively, where significant differences were observed (Z=4.837, 6.904, P<0.05).

In the continuous follow-up of cirrhotic nodules, CEUS can detect the hemodynamic changes in malignant nodules early, which has better diagnostic value than conventional ultrasound.