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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (11) : 1225 -1231. doi: 10.3877/cma.j.issn.1672-6448.2022.11.012

腹部超声影像学

肝细胞腺瘤的临床及超声特点分析
邹旻红1, 林伟珍1, 黄庆2, 蒋叶3, 张娈景1(), 郑荣琴1,()   
  1. 1. 510630 广州,中山大学附属第三医院超声科
    2. 510630 广州,中山大学附属第三医院病理科
    3. 510013 广州市第一人民医院(华南理工大学附属第二医院)胃肠外科
  • 收稿日期:2021-07-06 出版日期:2022-11-01
  • 通信作者: 张娈景, 郑荣琴
  • 基金资助:
    广东省医学科学技术研究基金项目(A2019526); 广州市科技计划项目(202102010024)

Clinical and contrast-enhanced ultrasound characteristics of hepatocellular adenoma

Minhong Zou1, Qing Huang1, Ye Jiang2, Luanjing Zhuang3, Rongqin Zheng1,()   

  1. 1. Department of Ultrasound, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
    2. Department of Pathology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
    3. Department of Gastrointestinal Surgery, Guangzhou First People's Hospital (The Second Affiliated Hospital of South China University of Technology), Guangzhou 510013, China
  • Received:2021-07-06 Published:2022-11-01
  • Corresponding author: Rongqin Zheng
引用本文:

邹旻红, 林伟珍, 黄庆, 蒋叶, 张娈景, 郑荣琴. 肝细胞腺瘤的临床及超声特点分析[J/OL]. 中华医学超声杂志(电子版), 2022, 19(11): 1225-1231.

Minhong Zou, Qing Huang, Ye Jiang, Luanjing Zhuang, Rongqin Zheng. Clinical and contrast-enhanced ultrasound characteristics of hepatocellular adenoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(11): 1225-1231.

目的

探讨肝细胞腺瘤(HCA)临床和超声特点,提高HCA的临床诊断能力。

方法

回顾性分析2008年1月至2021年5月中山大学附属第三医院经病理证实的10例HCA患者(HCA组)、17例经典型肝血管平滑肌脂肪瘤患者(CMAL组)和同时期随机检索的40例甲胎蛋白阴性的肝细胞癌患者[HCC(AFP-)组]的临床、影像及病理资料,采用t检验和χ2检验分别比较HCA组与CMAL组、HCC(AFP-)组临床特点、二维超声和超声造影表现的差异。

结果

HCA组患者发病年龄为(36.40±16.68)岁,与HCC(AFP-)组患者在性别(男/女:5/5 vs 36/4)、肝炎病毒感染(是/否:0/10 vs 40/0)等方面比较,差异均有统计学意义(χ2=8.672,P=0.010;χ2=50.000,P<0.001),而与CAML组差异无统计学意义(P均>0.05)。HCA组病灶回声不具有特异性,HCC(AFP-)组二维超声多表现为低回声,2组间差异具有统计学意义(χ2=8.404,P=0.011),而病灶数目、大小、形态及血供方面比较,2组差异均无统计学意义(P均>0.05);HCA与CAML组间病灶数目、大小、边界、回声、形态及血供差异均无统计学意义(P均>0.05)。HCA病灶超声造影增强模式主要表现为“高-等-等”,HCC(AFP-)组病灶超声造影增强模式表现为“高-低-低”,CAML组病灶超声造影增强模式表现为“高-高-等或高-等-等”。HCA组与CAML组间超声造影表现差异无统计学意义(P>0.05);HCA组与HCC(AFP-)组间门静脉期(高/等/低:1/6/3 vs 0/4/36)及延迟期(高/等/低:0/6/4 vs 0/1/39)增强表现比较,差异具有统计学意义(χ2=15.106,P<0.001;χ2=12.500,P=0.002),而动脉期增强表现差异无统计学意义(P均>0.05)。

结论

HCA具有一定的临床、常规二维超声和超声造影表现特点,对于女性、无乙肝感染、超声造影表现“高-等-等”的肝内占位性病变,应注意HCA的可能。

Objective

To summarize the clinical and ultrasound characteristics of hepatocellular adenoma to improve its diagnosis.

Methods

The clinical, imaging, and pathological data of 10 patients with hepatic adenoma (HCA group), 17 patients with hepatic angiomyolipoma (CMAL group), and 40 randomly selected AFP negative hepatocellular carcinoma patients (HCC (AFP-) group) diagnosed at the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to May 2021 were retrospectively reviewed. The t-test and chi-square test were used to compare the clinical characteristics and ultrasound and contrast-enhanced ultrasound findings in the three groups.

Results

The average age of onset in the HCA group was (36.40±16.68) years old. The gender (male/female: 5/5 vs 36/4) and hepatitis virus infection status (yes/no: 0/10 vs 40/0) of the patients in the HCA group (yes/no: 0/10 vs 40/0) were statistically different from those of the HCC (AFP-) group (χ2=8.672, P=0.010; χ2=50.000, P<0.001), but showed no statistical difference from those of the CAML group (P>0.05 for all). There were statistically significant differences in tumor echo between the HCA (unspecific tumor echo) and HCC (AFP-) (mostly hypoechoic) groups (χ2=8.404, P=0.011), though there was no significant difference in tumor number, size, morphology, or blood supply (P>0.05 for all). There was also no significant difference in tumor number, size, boundary, echo, morphology, or blood supply of lesions between the HCA and CAML groups (P>0.05 for all). The CEUS pattern was mainly "hyperintense-isointense-isointense" for HCA lesions, "hyperintense-hypointense-hypointense" for HCC (AFP-) lesions, and "hyperintense-hyperintense-isointense" or "hyperintense-isointense-isointense" for CAML lesions. The CEUS pattern between the HCA group and the CAML group was not statistically different. There was a statistically significant difference in the enhancement patter in the portal phase (hyperintense/isointense/hypointense: 1/6/3 vs 0/4/36; χ2=15.106, P<0.001) and the delayed phase (hyperintense/isointense/hypointense: 0/6/4 vs 0/1/39; χ2=12.500, P=0.002) between the HCA group and the HCC (AFP-) group, but there was no statistically significant difference in the arterial phase (P>0.05).

Conclusion

Hepatic adenoma has certain clinical, conventional two-dimensional ultrasound, and contrast-enhanced ultrasound features. Attention should be paid to the possibility of hepatic adenoma in women, patients without hepatitis B infection and those with a "hyperintense-isointense-isointense" pattern on CEUS.

表1 3组患者人口统计学和临床特征比较
表2 HCA、CAML、HCC(AFP-)组常规二维超声及超声造影表现
图1 39岁肝腺瘤女性患者超声及病理图。图a、b:肝右后叶下段内低-等回声团,边界欠清,血流不丰富;图c:动脉早期周边高增强;图d:动脉晚期整体高增强;图e:门静脉期呈稍高-等增强;图f:延迟期呈等增强;图g、h:HE及免疫组化[HE×200;CD34(+),×100]
图2 患者男性,69岁,肝细胞癌(甲胎蛋白阴性),慢性肝炎病史30余年。图a:肝S2/3内低回声团,边界尚清,周边可见点状血流信号;图b、c、d:超声造影动脉期高增强,门静脉及延迟期低增强;图e、f:HE及免疫组化[HE×200;Hep(+)(肝细胞抗原阳性),×200]
图3 27岁女性经典型肝血管平滑肌脂肪瘤患者超声造影及病理图。图a:肝S2/3内高回声团,边界清晰,内部未见明显血流信号;图b、c、d:超声造影动脉期增强,门静脉及延迟期消退不明显呈稍高增强;图e、f:HE及免疫组化[HE×100;HMB-45(+),×200]
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