原发性肝癌病理分化程度与超声造影表现的关系

Correlation of histopathologic grading of hepatocellular carcinoma with its contrast-enhanced ultrasound

目的评价原发性肝细胞癌(HCC)超声造影(CEUS)血供增强模式的显像特征,探讨HCC组织学分化程度与CEUS的关系。方法回顾术前应用Sono Vue超声造影剂的224例259个HCC病灶CEUS表现,将所获得曲线形态、灌注参数及灌注模式与标本的组织分化程度进行对照分析。结果不同分化程度HCC始增时间差异无统计学意义(P>0.05);低分化组达峰、增强和始消时间出现均最早,其次为中分化组,高分化组最晚;低分化组增强时间和廓清时间均最短,其次为中分化组,高分化组最长,各组间比较差异有统计学意义(P<0.01)。动脉相早期造影剂灌注模式分为蛛网样、放射样及混合样三类,高分化组以放射样为主28例(47.14%),蛛网样最少7例(14.29%);低分化组大部分表现为蛛网样88例(69.29%),只有6例(4.73%)为放射样;中分化组大部分为混合样(49/83,59.04%)。结论不同分化程度HCC超声造影声学定量参数变化特征及动脉相灌注模式不同,CEUS可作为评估HCC分化程度及生物学行为的可靠方法。

Objective To explore the correlation between the enhancement pattern of hepatocellular carcinoma （HCC） on contrast-enhanced ultrasound （CEUS） and its tumor differentiation on histopathology. Methods HCC lesions （n=259） from 224 patients were retrospectively evaluated with CEUS and histopathological examination. CEUS was performed with SonoVue. The characteristics of blood perfusion and parameters of the time-intensity curve （TIC） were analyzed by ACQ software. Histopathological diagnoses were decided base on Edmonson grading system. Results Pathologic grading of HCC was not related to the arrival time（P〈0.05）;The washing-out time point and the enhancement time point and peak time point all appeared earlier in poorly differentiated HCC group, than those in moderately differentiated HCC group than those in well differentiated HCC group（P〈0.01）;The enhancement time point and the expurgation time point are shorter in poorly differentiated HCC group than those in moderately differentiated HCC group than those in well differentiated HCC group. All differences were with statistical significance. The mode of arterial perfusion in early stage was divided into 3 types：spider web type, radiative type and mixed type. The well differentiated HCC group mainly presented as radiative type （ 28/49, 47.14%）. But the most of poorly differentiated HCC group mainly present as spider web type（88/127, 69.29%）. The mix type was more common in moderately differentiated HCC group（49/83, 59.03%）. Conclusion CEUS show different features of TIC parameters and blood perfusion in different pathological stages of HCC lesions so it can serve as a method to assess the biological behavior of hepatocellular carcinoma.