肝脏肿瘤不典型超声造影表现及其相关因素探讨

Contrast-enhanced ultrasonographic atypical characteristics of liver neoplasms and the associated factors

目的探讨声诺维(SonoVue)超声造影在肝脏肿瘤中的不典型表现及临床应用价值。方法采用新型超声造影剂SonoVue对80例肝肿瘤患者行灰阶成像超声造影检查,其中发现不典型超声造影表现9例,均行超声引导下穿刺活检病理检查及组织流式细胞仪DNA干系分析。结果9例肝占位性病变患者(原发性肝细胞癌4例、肝母细胞瘤1例,胆管细胞癌2例、血管瘤1例、肝结核1例)中4例原发性肝细胞癌增强方式不同。3例表现为快进慢出的增强方式,1例仅见肿瘤内一小结节表现为快进快出的强化方式,而其余大部未见增强。DNA分析前3例均为二倍体干系,第4例造影增强部分为异倍体干系,未增强部分为二倍体干系。肝母细胞瘤仅部分表现为快进快出的增强方式,其余部分未见增强;DNA分析为异倍体干系。1例胆管细胞癌表现为周边和内部少许小血管增强,整个肿瘤未见明显增强,另1例则未见增强;DNA分析均为高增殖改变。血管瘤呈快进慢出且其内部呈充盈缺损的增强方式;DNA分析为二倍体干系。肝结核表现为不增强,呈造影剂充填缺损改变;DNA分析为二倍体干系。结论不同类型肝肿瘤病变超声造影形成不同的增强方式。同一类型肝肿瘤因其分化程度与生物学特性不同,其肿瘤细胞与间质成分构成不同,也可有不同的造影改变,有待进一步研究。

Objective To evaluate the atypical characteristics of contrast-enhanced uhrasonography with SonoVue in benign and malignant hepatic tumors and their clinical value. Methods Double real-time gray-scale contrast-enhanced uhrasonography with SonoVue was performed in 80 patients with hepatic tumors. Among them, atypical ultrasonic features were found in 9 patients, including 4 with primary hepatic carcinoma, 1 with hepatoblastoma, 2 with peripheral cholangioeellular carcinoma, 1 with hepatic hemangioma, 1 with hepatic tuberculosis. All the 9 cases were examined by ultrasound-gulded fine needle aspiration biopsy and flow cytometric DNA analysis. Results The ultrasonic features and DNA analysis of 9 patients with space-occupying lesions were as follows. After injection of SonoVue, the 4 hepatic carcinoma lesions showed different enhancement patterns, of them 3 cases showed quick enhancement in early artery phase and slow disappearance in portal vein phase and late phase; the 4th case showed that only a small part of the tumor enhanced quickly in early artery phase and disappeared quickly in portal vein phase and late phase, with the rest without enhancement. On DNA analysis, the first 3 cases had diploid stem system, while the 4th ease had aneuploid stem system at the enhancement part and diploid stem system at no enhancement part. In 1 ease of hepatoblastoma, because of necrotic lesion, only part of it enhanced quickly in early artery phase and disappeared quickly in portal vein phase and late phase. DNA analysis showed aneuploid stem system. In 2 cases of peripheral eholanglocellular carcinoma, the first showed that only several small blood vessels enhanced at periphery of and within the lesion. The second had no enhancement in all phases. DNA analysis showed the tumor cells of both cases were in hyperproliferation. In one case of hepatic hemangioma it enhanced quickly in early artery phase and disappeared Slowly in portal vein phase and late phase. DNA analysis showed diploid stem system. In one case of hepatic tuberculosis no enhancement occurred in all phases. DNA analysis showed diploid stem system. Conclusions Different liver lesions were characterized by different enhancement patterns on the contrast-enhanced ultrasonography. Because of different degrees of differentiation and biological characteristics as well as the different components of tumor cells and mesenchymal tissue, the same type of tumor may show different enhancement patterns, thus further study is needed in this field of ultrasound.