原发性肝细胞癌不同分化程度超声造影模式分析

Association of histopathologic grading and contrast-enhanced ultrasound in hepatocallular carcinoma

目的探讨原发性肝细胞癌(HCC)的超声造影增强表现及与分化程度的相关性。方法选取我院602例肝脏占位性病变经超声造影检查及手术或穿刺活检病理确诊为HCC中93例患者的112个病灶,记录其超声造影增强时间,分析不同分化程度肝癌的增强时相及灌注模式。结果93例(112个癌灶)中病理诊断为中低分化HCC65例(74个癌灶),高分化HCC28例(38个癌灶)。中低分化HCC组癌灶平均大小(3.99±2.08)cm,高分化HCC组癌灶平均大小(3.38±1.44)cm,两组相比差异有统计学意义(P<0.05)。中低分化HCC74灶(100%)25s内快速增强,71灶(95.9%)90s内快速退出;高分化HCC38灶(100%)25s内快速增强,22灶(57.9%)90s内快速退出,16灶(42.1%)90s后缓慢退出,不同分化程度HCC退出时间相比差异有统计学意义(P<0.05)。结论HCC超声造影增强表现与分化程度有一定相关性,退出缓慢病灶可能分化程度较高。

Objective To investigate the correlation of contrast enhanced ultrasound (CEUS) manifestations with histopathologic grading of hepatocellular carcinoma (HCC). Methods Among 602 cases performed CEUS, ninety-three cases with 112 lesions confirmed by surgery or biopsy were reviewed in this study. The enhancement time and patterns were analyzed according to the degrees of pathological differentiation. Results There were 74 moderate to poor differentiated HCCs and 38 well-differentiated HCCs. The average sizes of moderate to poor and well-differentiated HCCs were 3.99±2.08 cm and 3.38±1.44 cm respectively . Significant difference of the average sizes was observed between moderate to poor differentiated and well-differentiated HCCs. All 74 moderate to poor differentiated HCCs were quickly enhanced within 25 s and 95.9% (71 lesions) of them were quickly washed out within 90 s. All 38 well-differentiated HCCs were enhanced within 25 s and 42.1% (16 lesions) were washed out slowly beyond 90 s. The wash-out time of the two types had significant differences (P<0.05). Conclusions Our study shows that the enhancement manifestations of HCCs are related to pathological grading,Those lesions which were washed out slowly may be well differentiated.