原发性和转移性肝癌肿块及肝脏的血流动力学变化

Hemodynamic changes of liver with primary and secondary tumors using color Doppler ultrasonography

目的 了解原发性肝癌 (HCC)和转移性肝癌 (MHC)肿块及肝脏的彩色多普勒超声表现 ,为其诊断和鉴别诊断提供依据 .方法 彩色多普勒血流显像 (CDFI)观察 183个HCC肿块、96个 MHC肿块 ,及其肝动脉、门静脉的血流情况 ,分别检测其最大血流速度 (vmax)和阻力指数 (RI) .将两组资料分别分为小肝癌型、结节型及块状型进行对比分析 .结果 随着肿块增大 ,两组肿块血供增加 .HCC以瘤内双重供血为主 ,vmax和 RI均随肿块增大而增高 ;MHC以瘤周双重供血为主 ,随肿块增大 RI增高 ,三型肿块 vmax均为 30 cm· s- 1左右 ,随肿块增大无明显变化 (P>0 .0 5 ) .两组患者肝动脉内径、vmax随肿块增大而增加 ,HCC组 RI无明显变化 ,MHC组RI随之增大 .HCC组门静脉内径和 vmax随肿块增大无显著变化 ;而 MHC组内径增加 ,vmax却逐渐降低 .结论 原发性与转移性肝癌的肿块和肝脏血流动力学表现明显不同 。

AIM Characteristics of hemodynamics for hepatocelluler carcinoma (HCC) and metastatic hepatic cancer (MHC) using color Doppler flowing imaging (CDFI) of were analysed to tender for diagnosis and differential diagnosis evidences. METHODS 183 tumors with HCC and 96 tumors with MHC were studied using CDFI, as well as the hemodynamic changes of hepatic artery and portal vein. The maximum blood flow velocity ( v max ) (the peak systolic flow velocity) and the resistant index (RI) were measured. Tumors were classified into three types: Small liver cancer, node liver cancer and lump liver cancer. All the measurements were compared among them. RESULTS The larger the diameter of tumor, the richer the blood flow. In HCC combined pattern predominated in introtumor blood flow, which Vmax and RI increased with the enlargement of tumor.As to MHC combined pattern predominated in peritumor blood flow, which RI increased accordingly. All the v max of three types in MHC were 30 cm·s -1 without significant differences( P > 0.05). The hepatic artery diameter and v max increased accordingly in both groups, so did RI in MHC but in HCC. The diameter of portal vein and its v max remained in HCC group but reduced in MHC group. CONCLUSION There are significant differences between the patterns of hemodynamic changes of masses and livers in HCC and those of in MHC. CDFI is important for the diagnosis and differential diagnosis of HCC and MHC.