Feasibility research of preoperative evaluation of neoplastic microvascular morphology in hepatocellular carcinoma patients using contrast-enhanced ultrasound

doi:10.3877/cma.j.issn.1672-6448.2015.06.008

Abstract

Abstract:

Objective

To explore the feasibility of contrast-enhanced ultrasonograhy (CEUS) in preoperative classification of hepatocellular carcinoma (HCC) microvascular morphology.

Methods

Totally 94 HCC patients who underwent CEUS were analyzed retrospectively. And the offline time-intensity curve (TIC) were drawn using SonoTumor. The tumor size, alpha fetoprotein (AFP), cirrhosis, Child-Pugh classification, tumor differentiation and TNM stage were statistically analyzed. The intratumoral microvessels of HCC in 94 cases were evaluated by CD34 immunohistochemical staining. The relationship between intratumoral microvessel morphology and CEUS parameters were analyzed.

Results

CD34 immunohistochemical staining showed three distinct microvessel types in 94 cases of HCC: 28 cases of capillary-like type, 14 cases of sinusoid-like type and 52 cases of mixed type. There were no significant differences of clinical data among three microvascular morphology types. The parameters of peak strength (PE), rise time (RT), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-in area under the curve (WiAUC) and mean transit time (MTT) in 28 cases of capillary-like type were (4 350.7±2 566.0) a.u, (10.7±3.2) s, (717.0±489.9) a.u, (12 820.3±8 331.6) a.u, (128 240.8±74 487.1) a.u, (71.9±33.1) s. Those parameters in 14 cases of sinusoid-like type were (2 471.6±1 107.1) a.u, (16.2±4.2) s, (321.9±171) a.u, (5 561.4±2 938.0) a.u, (86 780.1±47 563.7) a.u, (117.8±69.6) s. And in 52 cases of mixed type they were (3 563.2±2 343.1) a.u, (14.1±4.8) s, (519.4±403.2) a.u, (9 015.3±6 884.7) a.u, (110 208.4±77 511.3) a.u, (107.5±88.2) s respectively. The CEUS parameters of WiR, WiPI in capillary-like type HCC patients were higher than sinusoid-like type and mixed type HCC patients, while RT was lower than sinusoid-like type and mixed type HCC patients, and the differences were significant (WiR: t=3.87, 3.3, both P=0.05; WiPI: t=2.96, 2.06, both P=0.05; RT: t=3.19, 2.34, both P=0.05). The parameter of PE in capillary-like type HCC patients were significantly higher than that in sinusoid-like type HCC patients (t=2.51, P=0.05). And the parameter of PE in capillary-like type HCC patients was higher than mixed HCC patients, but there was no significant difference. The parameters of PE, WiR and WiPI in mixed type HCC patients were higher than that in sinusoid-like type HCC patients, while RT in mixed type HCC patients were lower than that in sinusoid-like type HCC patients, but there were no significant differences. No significant differences of WiAUC and MTT were observed in HCC patients with different microvascular morphology.

Conclusions

There were significant differences of CEUS parameters in different microvascular morphology types. And CEUS, as a non-invasive method, can be used for preliminary preoperative prediction of microvascular morphology in HCC patients.

Key words: Carcinoma, Hepatocellular, Microvascular, Ultrasonograhy, Contrast media

Qingguang Lin, Ruhai Zou, Jianwei Wang, Feng Han, Xiaoqing Pei, Anhua Li. Feasibility research of preoperative evaluation of neoplastic microvascular morphology in hepatocellular carcinoma patients using contrast-enhanced ultrasound[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(06): 453-458.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2015.06.008

https://chaosheng.cma-cmc.com.cn/EN/Y2015/V12/I06/453

Figures/Tables 5

References 16

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临床参数		毛细血管型（n=28）	血窦型（n=14）	混合型（n=52）	χ²值	P值
性别		?	?	?	-	0.61^a
?	男性	27	13	46	?	?
?	女性	1	1	6	?	?
年龄（岁）		?	?	?	0.28	0.87
?	≤50	12	7	22	?	?
?	>50	16	7	30	?	?
乙肝病毒感染		?	?	?	-	0.68^a
?	阴性	5	1	6	?	?
?	阳性	23	13	46	?	?
肝硬化背景		?	?	?	0.82	0.67
?	正常	12	5	17	?	?
?	肝硬化	16	9	35	?	?
肝功能Child- 　Pugh分级		?	?	?	-	0.69^a
?	A级	27	14	48	?	?
?	B级	1	0	4	?	?
甲胎蛋白浓度　（μg/L）		?	?	?	-	0.18^a
?	<20	9	10	22	?	?
?	20 ~ 400	8	2	10	?	?
?	>400	11	2	20	?	?
肿瘤最大径　（cm）		?	?	?	1.49	0.48
?	≤5	15	9	35	?	?
?	>5	13	5	17	?	?
卫星结节		?	?	?	-	0.72^a
?	有	19	11	40	?	?
?	无	9	3	12	?	?
肿瘤包膜		?	?	?	0.12	0.94
?	无/不完整	15	8	27	?	?
?	有	13	6	25	?	?
血管侵犯		?	?	?	-	0.12^a
?	无	28	12	49	?	?
?	有	0	2	3	?	?
TNM分期		?	?	?	0.24	0.89
?	Ⅰ/Ⅱ期	16	9	32	?	?
?	Ⅲ/Ⅳ期	12	5	20	?	?
病理分级		?	?	?	2.30	0.32
?	Ⅰ/Ⅱ级	19	10	28	?	?
?	Ⅲ/Ⅳ级	9	4	24	?	?

临床参数		毛细血管型（n=28）	血窦型（n=14）	混合型（n=52）	χ²值	P值
性别		?	?	?	-	0.61^a
?	男性	27	13	46	?	?
?	女性	1	1	6	?	?
年龄（岁）		?	?	?	0.28	0.87
?	≤50	12	7	22	?	?
?	>50	16	7	30	?	?
乙肝病毒感染		?	?	?	-	0.68^a
?	阴性	5	1	6	?	?
?	阳性	23	13	46	?	?
肝硬化背景		?	?	?	0.82	0.67
?	正常	12	5	17	?	?
?	肝硬化	16	9	35	?	?
肝功能Child- 　Pugh分级		?	?	?	-	0.69^a
?	A级	27	14	48	?	?
?	B级	1	0	4	?	?
甲胎蛋白浓度　（μg/L）		?	?	?	-	0.18^a
?	<20	9	10	22	?	?
?	20 ~ 400	8	2	10	?	?
?	>400	11	2	20	?	?
肿瘤最大径　（cm）		?	?	?	1.49	0.48
?	≤5	15	9	35	?	?
?	>5	13	5	17	?	?
卫星结节		?	?	?	-	0.72^a
?	有	19	11	40	?	?
?	无	9	3	12	?	?
肿瘤包膜		?	?	?	0.12	0.94
?	无/不完整	15	8	27	?	?
?	有	13	6	25	?	?
血管侵犯		?	?	?	-	0.12^a
?	无	28	12	49	?	?
?	有	0	2	3	?	?
TNM分期		?	?	?	0.24	0.89
?	Ⅰ/Ⅱ期	16	9	32	?	?
?	Ⅲ/Ⅳ期	12	5	20	?	?
病理分级		?	?	?	2.30	0.32
?	Ⅰ/Ⅱ级	19	10	28	?	?
?	Ⅲ/Ⅳ级	9	4	24	?	?

分型	例数	PE（a.u）	RT（s）	WiR（a.u）	WiPI（a.u）	WiAUC（a.u）	MTT（s）
毛细血管型	28	4 350.7±2 566.0^a	10.7±3.2^b	717.0±489.9^c	12 820.3±8 331.6^d	128 240.8±74 487.1	71.9±33.1
血窦型	14	2 471.6±1 107.1	16.2±4.2	321.9±171.8	5 561.4±2 938.0	86 780.1±7 563.7	117.8±69.6
混合型	52	3 563.2±2 343.1	14.1±4.8	519.4±403.2	9 015.3±6 884.7	110 208.4±77 511.3	107.5±88.2
F值	?	3.22	8.93	4.67	5.55	1.54	2.73
P值	?	0.04	0.00	0.01	0.00	0.22	0.71

分型	例数	PE（a.u）	RT（s）	WiR（a.u）	WiPI（a.u）	WiAUC（a.u）	MTT（s）
毛细血管型	28	4 350.7±2 566.0^a	10.7±3.2^b	717.0±489.9^c	12 820.3±8 331.6^d	128 240.8±74 487.1	71.9±33.1
血窦型	14	2 471.6±1 107.1	16.2±4.2	321.9±171.8	5 561.4±2 938.0	86 780.1±7 563.7	117.8±69.6
混合型	52	3 563.2±2 343.1	14.1±4.8	519.4±403.2	9 015.3±6 884.7	110 208.4±77 511.3	107.5±88.2
F值	?	3.22	8.93	4.67	5.55	1.54	2.73
P值	?	0.04	0.00	0.01	0.00	0.22	0.71

病理分级	例数	PE（a.u)	RT（s）	WiR（a.u)	WIPI（a.u)	WiAUC（a.u)	MTT（s）
Ⅰ级	10	4 176.8±3 131.4	11.3±4.5^a	690.4±486.8	12 421.2±8 313.7	132 381.6±105 480.5	86.6±39.8
Ⅱ级	47	3 389.7±2 011.2	14.8±5.3	484.5±352.1	8 181.2±5 656.8	101 548.9±65 103.4	107.5±88.2
Ⅲ/级	37	3 800.7±2 506.6	12.2±3.3	592.4±483.5	10 726.8±8 539.2	119 997.1±73 658.9	82.4±39.3
F值	?	0.62	4.49	1.30	2.13	1.08	1.98
P值	?	0.54	0.01	0.28	0.13	0.34	0.14

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