超声造影非典型肝癌的血流动力学表现及病理特征分析

Correlation between hemodynamics of atypical primary liver carcinomas on contrast-enhanced ultrasonography and pathological features

目的：探讨超声造影表现不典型的原发性肝癌的血流动力学基础。方法：分析造影表现不符合原发性肝癌诊断标准的123例原发性肝恶性肿瘤的血流动力学表现及与病理特征阃的关系。结果：从超声造影增强方式分析，病灶呈斑片状或环状增强者81例，不同肿瘤组中出现不典型增强方式的比例以胆管细胞性肝癌和少见类型肿瘤组以及肿瘤直径大于3cm组多见，且差异有统计学意义（P〈0．01）；造影增强时相不典型方面，肿瘤开始增强与肝实质同步或晚于肝实质、门脉期未减退者42例，与肝癌的分化程度密切相关。结论：原发性肝癌中因病理类型和分化程度不同而出现相应的造影表现，分析造影增强特征有助于特殊类型的原发性肝癌的诊断。

Objective To investigate the correlation between hemodynamics of atypical primary liver carcinomas on contrast-enhanced ultrasonography and pathological features. Methods One hundred and twenty-three patients with atypical primary liver carcinomas on contrast enhanced ultrasonography according to the diagnostic criteria of contrast-enhanced ultrasonography were enrolled. The sonographic patterns and pathological features were analyzed. Results The atypical patterns of mosaic or rim-like enhancement were detected in 81 cases. The atypical patterns appeared in cholangiocarcinomas or some pathologically special malignancies were significantly frequent compared to those in hepatocellular carcinomas （ P 〈0.01 ）, and mostly in large tumors （〉3 cm）. The atypical phases were that intratumoral enhancement was similar to or later than the liver parenchyma at arterial phase and no wash-out at portal phase in 42 cases. There was a close relationship between enhancement phases and differentiation of tumor cells. Conclusions Primary liver carcinomas show special enhancement patterns on contrast-enhanced ultrasonography based on the special pathology and differentiation of tumor cells. It is helpful in the diagnosis of special primary liver carcinomas to analyze the enhancement patterns.