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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） ›› 2017, Vol. 14 ›› Issue (03) : 200 -205. doi: 10.3877/cma.j.issn.1672-6448.2017.03.008

所属专题： 文献；

腹部超声影像学

超声造影廓清速度评估富血供肝细胞癌分化程度的价值
覃夏川1, 周翔2,†(), 刘学彬1, 马果丰1, 杨姣1   
  1. 1. 637000　四川省南充市中心医院超声科
    2. 100021　北京，中国医学科学院肿瘤医院超声科
  • 收稿日期:2016-06-26 出版日期:2017-03-01
  • 通信作者: 周翔

Assessment of the pathological differentiation of hypervascular hepatocellular carcinoma using washout speed in contrast-enhanced ultrasound

Xiachuan Qin1, Xiang Zhou2,†(), Xuebin Liu1, Guofeng Ma1, Jiao Yang1   

  1. 1. Department of Ultrasonography, Nanchong Central Hospital, Sichuan Province, Nanchong 637000, China
    2. Department of Ultrasonography, Cancer Hospital Chinese Academy Medical Sciences, Beijing 100021, China
  • Received:2016-06-26 Published:2017-03-01
  • Corresponding author: Xiang Zhou
  • About author:
    Corresponding author: Zhou Xiang, Email:
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覃夏川, 周翔, 刘学彬, 马果丰, 杨姣. 超声造影廓清速度评估富血供肝细胞癌分化程度的价值[J]. 中华医学超声杂志（电子版）, 2017, 14(03): 200-205.

Xiachuan Qin, Xiang Zhou, Xuebin Liu, Guofeng Ma, Jiao Yang. Assessment of the pathological differentiation of hypervascular hepatocellular carcinoma using washout speed in contrast-enhanced ultrasound[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(03): 200-205.

目的

探讨超声造影（CEUS）廓清速度评估富血供肝细胞癌（HCC）分化程度的价值。

方法

收集2009年4月至2014年12月四川省南充市中心医院收治的经手术后病理确诊的富血供HCC患者271例，术前2~3 d行CEUS检查。对HCC的CEUS廓清速度进行分级。采用Kruskal-Wallis秩和检验比较不同分化程度HCC的CEUS廓清速度差异；采用Spearman相关分析分析HCC分化程度与CEUS廓清速度的相关性；绘制CEUS廓清速度判断HCC分化程度的操作者工作特征（ROC）曲线。

结果

本组271个HCC中，18个为高分化，150个为中分化，103个为低分化或未分化。其中19个（7.0%）为CEUS廓清速度1级，65个（24.0%）为CEUS廓清速度2级，157个（57.9%）为CEUS廓清速度3级，30个（11.1%）为CEUS廓清速度4级。不同分化程度HCC的CEUS廓清速度差异有统计学意义（χ2=179.8238，P<0.001），进一步组间两两比较结果显示，高分化与中分化、高分化与低分化、中分化与低分化HCC的CEUS廓清速度差异均有统计学意义（χ2=91.23、95.16、29.59，P均<0.01）。CEUS廓清速度越快的HCC分化程度越低，CEUS廓清速度越慢的HCC分化程度越高。ROC曲线显示，廓清速度1级是CEUS廓清速度区分高分化和中低分化HCC的阈值，CEUS廓清速度1级诊断高分化HCC的敏感度和特异度分别为98.0%和77.8%，阳性预测值和阴性预测值分别为96.0%和48.8%，阳性似然比和阴性似然比分别为1.9和0.01。廓清速度4级是CEUS廓清速度区分低分化与高中分化HCC的阈值，CEUS廓清速度4级诊断低分化HCC的敏感度和特异度分别为24.3%和97.0%，阳性预测值和阴性预测值分别为65.3%和61.3%，阳性似然比和阴性似然比分别为3.2和0.7。

结论

CEUS廓清速度可在一定程度上反映HCC分化程度。CEUS廓清速度能有效判断高分化HCC，但对中低分化HCC难以有效判断。

关键词: 肝肿瘤, 细胞分化, 超声检查, 造影剂
Objective

To study the relationship between the washout speed in the contrast-enhanced ultrasound (CEUS) and the differentiation grading in pathology in patients with hypervascular hepatocellular carcinoma (HCC).

Methods

Totally 271 patients who underwent complete resection for hypervascular HCC from April 2009 to December 2014 at Nanchong Central Hospital were included in this study. CEUS examinations were perfomred in all patients 2-3 days before liver resection. A timer on the ultrasound screen displayed the time elapsed since the saline flush was used to determine time to washout. The washout rate were categorized into four levels based on enhancement in portal venous phase and delayed phase. The differentiation grade and the washout speed were compared using Kruskal-Wallis test.

Results

All 271 (100%) lesions were arterially enhanced with different washout rate. Washout speed 1 was found in 19 patients (7.0%), while speed 2 in 157 patients (57.9%), speed 3 in 65 (24.0%), and speed 4 in 30, respectively. The washout speed had a significant correlation with the differentiation (χ2=179.8238, P<0.001). The faster washout speed, the higher differentiated. Washout speed 1 could distinghuish well-differentiated from the poor and moderately differentiated tumor. The sensitivity and specificity of preoperative washout speed 1 to identify well histologic grade were 98.0% and 77.8%, the positive predictive value and negative predictive value were 96.0% and 48.8%, and the positive likelihood ratio and negative likelihood ratiowere were 1.9 and 0.01. Washout speed 4 could distinghuish poor differentiated from well and moderately differentiated tumor The sensitivity and specificity of preoperative washout speed 4 to identify poor histologic grade were 24.3% and 97.0%, the positive predictive value and the negative predictive value were 65.3% and 61.3%, and the positive likelihood ratio and negative likelihood ratiowere were 3.2 and 0.7.

Conculsions

Washout speed can reflect the degree of differentiation roughly. Washout speed can effectively diagnose the well-differentiated HCC, but it is difficult for moderate and poor differentiated HCC.

Key words: Liver neoplasms, Cell differentiation, Ultrasonography, Contrast media
图1~4 高分化肝细胞癌超声声像图及病理图。图1为常规超声声像图示肿瘤位于肝S5段，大小约10 cm×8 cm；图2为超声造影动脉期肿瘤呈快速高增强；图3为超声造影延迟期（220 s）肿瘤呈高增强，并未廓清；图4示病理结果为高分化肝细胞癌（HE，×200）
图5~8 低分化肝细胞癌超声声像图及病理图。图5为常规超声声像图示肿瘤位于肝S5段，大小约2.6 cm×2.4 cm；图6为超声造影动脉期肿瘤呈快速高增强；图7为超声造影动脉晚期（31 s）肿瘤开始廓清；图8示病理结果为低分化肝细胞癌（HE，×200）
表1 不同分化程度HCC的CEUS廓清速度比较（个）
组别 个数 CEUS廓清速度
1级 2级 3级 4级
高分化HCC 18 14 4 0 0
中分化HCC 150 5 43 97 5
低分化HCC 103 0 18 60 25
χ2值 ? 71.394
P值 ? <0.001
图10 超声造影廓清速度区分高分化和中低分化肝细胞癌的操作者工作特征曲线。其曲线下面积为0.96
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