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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (04) : 281 -285. doi: 10.3877/cma.j.issn.1672-6448.2016.04.010

所属专题： 文献；

腹部超声影像学

肝细胞癌超声造影特征与其分化程度的关系
赖江琼1, 徐超丽2, 刘国安1, 杨斌2,†()   
  1. 1. 362000　泉州，解放军第一八〇医院超声科
    2. 210000　南京军区总医院超声科
  • 收稿日期:2015-07-01 出版日期:2016-04-01
  • 通信作者: 杨斌

Features of primary hepatocellular carcinoma at contrast-enhanced ultrasonography: comparison with histologic differentiation

Jiangqiong Lai1, Chaoli Xu2, Guoan Liu1, Bin Yang2,†()   

  1. 1. Department of Ultrasound, 180th Hospital of Chinese People's Liberation Army, Quanzhou 362000, China
    2. Department of Ultrsound, Genenal Hospital of Nanjing Command, Nanjing 210000, China
  • Received:2015-07-01 Published:2016-04-01
  • Corresponding author: Bin Yang
  • About author:
    Corresponding author: Yang Bin, Email:
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引用本文：

赖江琼, 徐超丽, 刘国安, 杨斌. 肝细胞癌超声造影特征与其分化程度的关系[J]. 中华医学超声杂志（电子版）, 2016, 13(04): 281-285.

Jiangqiong Lai, Chaoli Xu, Guoan Liu, Bin Yang. Features of primary hepatocellular carcinoma at contrast-enhanced ultrasonography: comparison with histologic differentiation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(04): 281-285.

目的

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。

方法

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。

结果

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。

结论

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。

关键词: 超声检查, 造影剂, 癌，肝细胞, 细胞分化
Objective

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

Methods

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.

Results

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.

Conclusions

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.

Key words: Ultrasonography, Contrast media, Carcinoma, hepatocellular, Cell differentiation
表1 不同直径HCC分化程度比较（例）
组别 例数 肿瘤分化程度
高分化 中分化 低分化
直径<3 cm HCC 20 2 13 5
直径3~5 cm HCC 15 5 6 4
直径>5 cm HCC 22 3 8 11
χ2值 ? 6.522
P值 ? >0.05
表2 不同直径HCC CEUS增强强度比较（例）
组别 例数 CEUS增强强度
均匀高增强 均匀等增强 不均匀高增强 不均匀等增强
直径<3 cm HCCa 20 14 4 1 1
直径3~5 cm HCC 15 8 1 6 0
直径>5 cm HCC 22 5 0 14 3
χ2值 ? 22.610
P值 ? <0.01
表3 不同直径HCC CEUS增强模式比较（例）
组别 个数 CEUS增强模式
快进快出 快进同出 快进慢出
直径<3 cm HCC 20 16 2 2
直径3~5 cm HCC 15 13 1 1
直径>5 cm HCC 22 19 2 1
χ2值 ? 1.057
P值 ? >0.05
图1，2 原发性高分化肝细胞癌超声造影图。图1示动脉期呈快速高增强；图2示延迟期造影剂仍未消退，箭头示肿块内造影剂滞留。左图为超声造影图，右图为常规超声声像图
表4 不同分化程度HCC CEUS增强强度比较（例）
组别 例数 CEUS增强强度
均匀高增强 均匀等增强 不均匀高增强 不均匀等增强
高分化HCC 10 4 3 3 0
中分化HCC 27 15 2 8 2
低分化HCC 20 8 0 10 2
χ2值 ? 8.090
P值 ? >0.05
表5 不同分化程度HCC CEUS增强模式比较（例）
组别 例数 CEUS增强模式
快进快出 快进同出 快进慢出
高分化HCCa 10 5 1 4
中分化HCC 27 25 2 0
低分化HCC 20 18 2 0
χ2值 ? 13.090
P值 ? <0.01
表6 有肝硬化HCC患者与无肝硬化HCC患者CEUS增强模式比较（例）
组别 个数 CEUS增强模式
快进快退 快进同退 快进慢退
有肝硬化HCC 36 29 4 3
无肝硬化HCC 21 17 2 2
P值a ? 1.000
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