探讨肝细胞癌（HCC）肿瘤大小、分化程度与超声造影（CEUS）特征之间的关系。

回顾性分析2010年1月至2015年1月南京军区南京总医院收治的行CEUS并经穿刺活检或手术病理证实的57例HCC患者CEUS表现。采用R×C表的χ²检验比较不同直径、不同分化程度HCC CEUS特征，进一步组间两两比较采用R×C表的χ²检验；采用Fisher确切概率法比较有无肝硬化HCC患者CEUS增强模式差异。

本组57例HCC患者，肿瘤直径≤3 cm 20例，直径3~5 cm 15例，直径>5 cm 22例；高分化10例，中分化27例，低分化20例；36例患者合并乙型病毒性肝炎相关性结节性肝硬化，21例患者肝脏正常或未形成肝硬化。（1）直径<3 cm HCC CEUS主要表现为均匀高增强；直径3~5 cm HCC CEUS主要表现为均匀或不均匀高增强；直径>5 cm HCC CEUS主要表现为不均匀高增强。直径<3 cm与直径3~5 cm、直径>5 cm HCC CEUS增强强度差异均有统计学意义（χ²=7.445，P<0.05；χ²=0.481，P<0.01），而直径3~5 cm与直径>5 cm HCC CEUS增强强度差异无统计学意义。直径<3 cm、直径3~5 cm与直径>5 cm HCC CEUS增强模式均以快进快出为主。不同直径HCC CEUS增强模式差异无统计学意义。（2）高、中、低分化HCC CEUS增强强度可为均匀或不均匀高增强。不同分化程度HCC CEUS增强强度差异无统计学意义。高分化HCC CEUS增强模式可为快进快出、快进同出或快进慢出，中、低分化HCC CEUS增强模式主要为快进快出。高分化与中分化、低分化HCC CEUS增强模式差异均有统计学意义（χ²=10.72，8.505，P均<0.01），中分化与低分化HCC CEUS增强模式差异无统计学意义。（3）有肝硬化HCC患者与无肝硬化HCC患者CEUS增强模式差异无统计学意义。

不同直径HCC CEUS增强强度有一定的差异，体积大的肿瘤多出现内部充盈缺损，可能与肿瘤的微血管分布和内部出血坏死有关。不同分化程度HCC CEUS增强模式有一定差异，对于高分化HCC，应适当延长造影剂消退的观察时间，有助于提高诊断准确率。

To investigate the characteristics of hepatocellular carcinoma (HCC) at contrast-enhanced ultrasonography (CEUS) with different tumor size and the degree of HCC histologic differentiation.

Of 57 consecutive patients with core needle biopsy or surgical specimen histologically proved HCC, the relationship between tumor size and histologic differentiation was analyzed by using R×C χ² test. The enhancement degrees and enhancement patterns of each group were compared, and the influence of cirrhosis on contrast-enhanced patterns was investigated by Fisher exact test.

There were 20 small HCC, 15 moderated-size HCC, 22 large HCC and 10 well differentiated HCC, 27 moderately differentiated HCC, 20 poorly differentiated HCC. And there were 36 patients with hepatitis B viral hepatitis related nodular cirrhosis, and 21 patients without nodular cirrhosis of the liver. (1) The enhancement degrees of small HCC were homogeneous hypervascularity, the moderated-size HCC were homogeneous hypervascularity or heterogeneous hypervascularity, and the large HCC were heterogeneous hypervascularity. The pattern of contrast-enhanced US has no significant difference among three groups.The small HCC showed a significantly different enhancement compared with moderated-size HCC and large HCC (χ²=7.445, P<0.05; χ²=0.481, P<0.01). (2) The well differentiated HCC, moderately differentiated HCC and poorly differentiated HCC could show homogeneous hypervascularity or heterogeneous hypervascularity, there were no significant differences on enhancement degree among three groups. The well differentiated HCC showed fast wash-in and fast wash-out, iso-wash-in and iso-wash-out or fast wash-in and late wash-out patterns. Moderated and poor differentiated HCC showed fast wash-in and fast wash-out. There were significant differences between well differentiated HCC with moderated HCC and poor HCC (χ²=10.702, 8.505, both P<0.01). But no significant dirrerence was found between moderated and poor HCC. (3) The enhancement pattern between patients with and without cirrhosis were compared, and negative result were obtained.

The enhancement degree was dependent with tumor size, the large tumor tend to present heterogeneous hypervascularity. It may be related to the microvescular density distribution and necrosis formation. The enhancement pattern was dependent with histologic differentiation. Extended observation in the portal phase is important to detect the occurence of late washout in well differentiated HCC, which is useful to improve the diagnostic accuracy of CEUS in HCC.