原发性肝癌的超声造影表现与生物学特性关系探讨

Relationship of the characteristics of enhanced-ultrasonography and biology of hepatocellular carcinoma

目的探讨原发性肝细胞癌超声造影的不同表现与其生物学特性的关系。方法临床确诊的原发性肝细胞癌(HCC)26例,肝内局灶性结节性增生(FNH)8例,采用超声造影剂SonoVue与Aloka 5500超声仪行实时双幅灰阶超声造影,所有病例均活检抽吸组织送病理组织学检查与流式细胞计(FCM)DNA分析。将超声造影表现分为典型组(即造影剂始增时间≤20 s,始退时间≤50 s的“快进快退”组),与非典型组(即始退时间>50 s的“快进慢退”组),并与DNA检测结果进行比较。结果26例HCC超声造影后呈典型与非典型表现的分别为18例与8例,8例FNH造影均呈非典型表现。DNA分析结果显示:HCC造影典型组的DNA表现为高增值的S期与G2/M期比率分别为(37.6±7.3)%与(14.0±2.1)%,均显著高于非典型组的(23.4±6.7)%与(8.4±1.7)%(均P<0.05)。后者又分别高于FNH组的(2.3±0.5)%与(1.6±0.4)%(均P<0.01)。同时18例典型组中33.3%(6/18)出现异倍体峰,不典型组与FNH组均未出现异倍体峰。HCC典型组中1例直径5.2cm的团块内仅见直径0.9 cm的结节呈典型的“快进快退”表现,其余部分呈造影剂充盈缺失现象,两部分病理组织学检查均为HCC,但结节部分出现异倍体峰,其余部分仅表现二倍体为主的改变。结论HCC超声造影表现典型者其DNA含量呈高增值状态,不典型者与FNH其DNA呈低增值或非增值的稳定状态,提示HCC的超声造影表现除反映血流动力学变化外,还与其生物学特性有密切关系。

Objective To probe the relationship of the characteristics of enhanced-uhrasonography and biology of hepatocellular carcinoma （HCC）. Methods Clinically proved 26 HCC and 8 focal nodule hyperplasia （FNH） were examined by double real-time grey-scale contrast-enhanced ultrasound with an intravenous administration of SonoVue. All the cases were taken aspiration biopsy for pathological histological examination and FCM DNA analysis. According to the show of contrast enhancement, the cases of HCC were divided into two groups which were typical group with enhancement beginning time ≤20 s and fadeaway beginning time ≤50 s and non-typical group with fadeaway beginning time 〉50s. The results of enhanced-ultrasonography were compared with those of DNA analysis. Results Twenty-six HCC included 18 cases vested in typical group and 8 in non typical group. Eight FNH were all vested in non-typical group. DNA analysis showed S period and G2/M ratios of HCC which were vested in typical group were （37.6 ± 7.3） % and （14.0 ± 2.1 ） %, respectively, markedly higher than those of HCC which were vested in non-typical group [（23.4 ± 6.7） % and （8.4 ± 1.7） %, P 〈0.05], and those of the latter were also higher than those of FNH [（2.3 ± 0. 5） % and （1.6 ± 0.4） %, P 〈0.01]. Aneuploid peak appeared in 33. 3 % （6/18） HCC which were vested in typical group and didn＇t appeared in non-typical group and FNH. One HCC in typical group with diameter 5.2 cm showed only a nodule with diameter 0.9 cm appeared ＂quick enhancement and quick fadeaway＂ and the other part didn＇t appeared enhancement. These two parts were all HCC in pathology examination, while the nodule part appeared aneuploid peak and the other only showed diploid in DNA analysis. Conclusions DNA analysis shows high proliferation state in HCC which are vested in , typical group and low or no proliferation state in non-typical group and FNH, which indicated ultrasonic contrast shows not only reflect the hemodynamics change of HCC but also relates to its characteristics.