肝细胞性肝癌超声造影分型与血管生成相关性研究

Study on the correlation between contrast-enhanced ultrasound perfusion imaging typing and vascularization

目的探讨肝细胞性肝癌（HCC）超声造影（CEUS）灌注显像分型与血管生成之间的关系，探讨该分型的临床意义。方法HCC患者89例113个病灶，选择反映大血管构筑形态的动脉相早期强化形式以及与微血管分布、部位及密度相关的增强后肿瘤大小变化及边界清晰与否等灌注参数进行观察分析。全部病例经病理证实，部分病例行免疫组化染色，测定微血管密度（microvessel density，MVD）。结果依CEUS改变将HCC灌注显像分为4型：树枝型、混合型、环绕型、网络型。树枝型异型性血管多，病理Ⅲ、Ⅳ级占79．1％，MVD高于其他各型。环绕型血管形态相对较规则，Ⅲ、Ⅳ级仅占12．5％，MVD低于其他类型。综合CEUS灌注特征并与病理分级、生长方式、MVD等对照，树枝型以浸润性生长为主，具有较强侵袭倾向。环绕型以膨胀性生长为主。其余两型介于二者之间为过渡型。结论CEUS灌注显像分型能够反映肿瘤血管构型及微血管密度与部位，并与肿瘤病理分级、生长方式等具有相关性。

Objective To study the significance and value of imaging typing by analyzing the correlation between contrast-enhanced ultrasound perfusion imaging typing and vascularization in patients with primary hepatocellular cancer. Methods The early enhanced arterial phase reflecting angioarchitecture,and the size and edge of enhanced tumor closely related to microvessel distribution, position and density, were observed and analyzed in 89 patients （113 lesions）. All the cases were pathologically proved, and some received immunohistochemisty staining and the microvessel density were recorded. Results The perfusion imagings were classified into 4 types according to changes on contrast-enhanced ultrasound, dendritic,mixed, circular and net-like type. Atypia vessels were commonly seen in dendritic type, and Ⅲ and Ⅳ accounted for 79.1 %. The microvessel density was higher than the other types. The circular type was relatively regular and III and IV accounted for 12.5%. The microvessel density was lower than the other types. Combined with the contrast-enhanced ultrasound perfusion imaging and compared with pathological grading, growing methods and mierovessel density, the dendritic type was characterized by infiltrative growth, and had strong invasion tendency. The circular type was characterized by expansive growth. And the other two types were characterized by transitional type. Conclusions Contrast-enhanced ultrasound can reflect the angioarchitecture, the microvessel density and the position,and it is related to the pathological grading and growing methods.