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。

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。

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。

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。

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).

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.

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.

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.