小肝癌超声造影特征与病理组织学分析研究

Characterization of small hepatocellular carcinoma by contrast-enhanced ultrasound and histopathology analysis

目的探讨小肝癌(直径≤3cm)超声造影特征与肿瘤分化程度及病理组织学类型间的关系。方法采用超声造影技术观察87例小肝癌患者,109个病灶的超声增强时间及增强模式;分析肿瘤分化程度及病理组织学类型的超声造影影像学特点。结果 109个小肝癌病灶,高分化52个,中分化38个,低分化19个。低分化肿瘤回声增强时间(12.2±2.14),显著少于高分化肿瘤(14.54±3.65),P<0.01,消退时间(46.57±9.15)早于中分化肿瘤(79.38±28.79),P<0.01;中分化肿瘤的消退时间显著早于高分化肿瘤(102.46±33.23),P<0.05。低分化肿瘤门静脉相和延迟相低增强比例(84.21%)显著高于高分化肿瘤(51.92%),P<0.01。与梁索型和假腺管型比较,实体型肿瘤的回声消退时间较短,门静脉相及延迟相低增强比例较高;纤维硬化型者动脉相高增强比例较低,门静脉相及延迟相高增强比例较高(P<0.05)。结论综合分析超声造影的影像学特征,对判断小肝癌的分化程度和与病理组织学类型具有重要的参考价值。

Objective To evaluate the correlation of contrast- enhanced ultrasound （CEUS） patterns with histopathology of small hepatocellular carcinoma （SHCC）. Methods CEUS was performed on 87 patients with 109 SHCC lesions. The enhancement time and patterns according to the pathologic differentiation degrees and histopathologic types were analyzed. Results 109 lesions were divided into 52 high differentiation lesions, 38 medium differentiation lesions and 19 low differentiation lesions. The enhance time of low differentiation lesions （12. 2 ±2. 14 ）was obviously shorter than that of high differentiation lesions（ 14. 54±3.65 ）P〈0. 01, the wash-out time of low differentiation lesions （46. 57 ±9.15 ）was earlier than that in medium differentiated lesions（79. 38±28.79）P〈0. 01, the wash-out time in medium differentiation lesions was earlier than that in high differentiation lesions（ 102.46±33.23 ） ,P〈0.05. The ratio of hypoeehoic nodules in low differentiation lesions was much higher than that in high differentiation lesions in portal venous and late phase （84. 21% vs 51.92%, P〈0.01 ）. Compared with the trabecular and glandular type lesions, the wash out in compact type lesions was much quicker in portal venous phase, the ratio of hypoechoic nodules in portal venous and late phase was higher. Meanwhile, the ratio of hyperechoic nodules in cirrhotic type lesions was much lower in arterial phase, while much higher in portal venous and late phase（P〈0.05）. Conclusion CEUS may provide valuable information for judgement of the differentiation degrees and histopathologic types of SHCC.