夏宇;姜玉新;戴晴;吕珂;高嫔;
XIA Yu;JIANG Yu-xin;DAI Qing;L Ke;GAO Pin;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院超声医学科

摘要(Abstract)：

目的探讨肝细胞肝癌的超声造影增强模式对于分化程度的诊断价值。方法回顾性分析81例手术病理证实的肝细胞肝癌患者的超声造影特点。将动脉期病灶内部开始增强、门脉期回声低于周边肝实质的增强模式定义为"快进快出"型;将动脉期病灶内部开始增强、延迟期回声低于周边肝实质的增强模式定义为"快进慢出"型。根据病理结果将肝细胞肝癌分为高分化及中低分化两组。总结分析增强模式对于分化程度的诊断价值。结果 81例肝细胞肝癌患者中,高分化肝细胞肝癌38例,中低分化者43例。17例(21.0%)高分化肝细胞肝癌超声造影表现为"快进慢出",21例(25.9%)高分化肝细胞肝癌表现为"快进快出",43例(53.1%)中低分化肝细胞肝癌表现为"快进快出"。"快进慢出"的增强模式在高分化肝细胞肝癌组较中低分化肝细胞肝癌组患者中更为常见(χ2=24.35,P<0.01)。"快进慢出"的增强模式诊断高分化肝细胞肝癌的敏感性44.7%,特异性100%,阳性预测值100%,阴性预测值67.2%,准确率74.1%。结论超声造影"快进慢出"模式对提示及诊断高分化肝细胞肝癌可能有帮助。
Objective To investigate the enhancement pattern features of hepatocellular carcinoma( HCC) on contrast-enhanced ultrasound( CEUS) and explore the diagnostic value of CEUS for predicting tumor differentiation.Methods CEUS features of 81 cases of pathologically confirmed HCC were retrospectively analyzed.The enhancement pattern was defined as "quick in-quick out"when the lesion was enhanced in arterial phase and showed as hypoechoic in portal phase; when the lesion was enhanced in arterial phase and showed as hypoechoic in late phase,the enhancement pattern was defined as "quick in-slow out".According to the final pathological results,HCCs were categorized into well-differentiated group and poorly-to-moderately differentiated group.The diagnostic value of CEUS for the HCC differentiation was summarized.Results Of these 81 HCC patients,38 were diagnosed as well-differentiated HCCs and 43 as poorly-to-moderately differentiated HCCs.The enhancement pattern was "quick in-slow out"in 17 patients( 21.0%,17 /81) with well-differentiated HCCs,"quick in-quick out"in 21 patients( 25.9%,21/81) with well-differentiated HCCs,and"quick in-quick out" in 43 patients( 53.1%,43 /81) with poorly-to-moderately differentiated HCCs.The"quick in-slow out"pattern was more common in the well-differentiated HCC group than in the poorly-to-moderately differentiated HCC( χ2= 24.35,P < 0.01).Its diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and accuracy rate were 44.7%,100%,100%,67.2%,and 74.1%,respectively.Conclusion The "quick in-slow out"enhancement pattern may be helpful for predicting and diagnosing the well-differentiated HCC.

关键词(KeyWords)： 超声造影;肝细胞肝癌;分化程度
contrast-enhanced ultrasound;hepatocellular carcinoma;differentiation

Abstract:

Keywords:

基金项目(Foundation): 教育部留学回国人员科研启动基金(M426300)

作者(Authors): 夏宇;姜玉新;戴晴;吕珂;高嫔;
XIA Yu;JIANG Yu-xin;DAI Qing;L Ke;GAO Pin;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

参考文献(References)：

• [1]Salvatore V,Bolondi L.Clinical impact of ultrasound-related techniques on the diagnosis of focal liver lesions[J].Liver Cancer,2012,1:238-246.
• [2]Friedrich-Rust M,Klopffleisch T,Nierhoff J,et al.Contrastenhanced ultrasound for the differentiation of benign and malignant focal liver lesions:a meta-analysis[J].Liver Int,2013,33:739-755.
• [3]Solbiati L,Tonolini M,Cova L,et al.The role of contrastenhanced ultrasound in the detection of focal liver lesions[J].Eur Radiol,2001,11(Suppl 3):E15-E26.
• [4]Bruix J,Sherman M,Llovet JM,et al.Clinical management of hepatocellular carcinoma.Conclusions of the Barcelona-2000 EASL Conference[J].J Hepatol,2001,35:421-430.
• [5]Yang H,Liu GJ,Lu MD,et al.Evaluation of the vascular architecture of focal liver lesions using micro flow imaging[J].J Ultrasound Med,2013,32:1157-1171.
• [6]Breedis C,Young G.The blood supply of neoplasms in the liver[J].Am J Pathol,1954,30:969-977.
• [7]Leen E,Angerson WJ,Yarmenitis S,et al.Multi-centre clinical study evaluating the efficacy of SonoVueTM(BR1),a new ultrasound contrast agent in Doppler investigation of focal hepatic lesions[J].Eur J Radiol,2002,41:200-206.
• [8]Quaia E,Degobbis F,Tona G,et al.Differential patterns of contrast enhancement in different focal liver lesions after injection of the microbubble US contrast agent SonoVue[J].Radiol Med,2004,107:155-165.
• [9]Cosgrove D.A revolution in liver ultrasound[J].Eur J Gastroenterol Hepatol,2007,19:1-2.
• [10]Hennedige T,Venkatesh SK.Imaging of hepatocellular carcinoma:diagnosis,staging and treatment monitoring[J].Cancer Imaging,2013,8:530-547.
• [11]Fan ZH,Chen MH,Dai Y,et al.Evaluation of primary malignancies of the liver using contrast-enhanced sonography:correlation with pathology[J].Am J Roentgenol,2006,186:1512-1519.
• [12]Kudo M,Tomita S,Kashida H,et al.Tumor hemodynamics in hepatic nodules associated with liver cirrhosis:relationship between cancer progression and tumor hemodynamic change[J].Nippon Shokakibyo Gakkai Zasshi,1991,88:1554-1565.
• [13]Xia Y,Jiang YX,Dai Q,et al.Contrast-enhanced ultrasound of hepatocellular carcinoma:correlation of washout time and angiogenesis[J].Clin Hemorheol Microcirc,2011,48:265-273.