复发性肝细胞性小肝癌超声造影强化模式量化分析

Quantitative analysis of contrast-enhanced ultrasound of recurrent small hepatocellular carrcinoma

目的:分析复发性肝细胞性小肝癌超声造影强化模式(CEUS)时间-强度曲线特征及临床意义。方法:将65例直径≤30 mm复发性肝细胞性小肝癌患者分组,42例复发时间≤2年为B1组,23例复发时间>2年为B2组,49例初发性肝细胞性小肝癌为A组,比较3组动脉期、门脉期、延迟期CEUS增强表现的异同,应用TIC分析软件对病灶进行定量分析,比较3组时间-强度曲线异同。绘制TIC定量参数的ROC曲线并计算曲线下面积。结果 :CEUS 3期增强表现:动脉期高增强B2组与A组比较差异有统计学意义(P′=0.008);门脉期等增强3组比较差异无统计学意义(P=0.078);延迟期低增强B2组与A组及B1组比较差异有统计学意义(P′=0.003,P′=0.005)。TIC定量参数比较:降支减半时间B2组与A组及B1组比较差异有统计学意义(P′=0.007,P′=0.013);上升时间、达峰时间、平均渡越时间3组比较差异无统计学意义(P=0.319,P=0.104,P=0.461);降支减半时间的曲线下面积0.841。结论:复发灶的强化模式与时间具有相关性,复发性肝细胞性小肝癌(>2年)CEUS强化模式不典型,CEUS应结合时间-强度曲线定量分析,从而为治疗和判断预后提供一定的临床价值。

Objective To analyze the characteristics and clinical value of time intensity curve（TIC） of contrast-enhanced ultrasound（CEUS） in recurrent small hepatocellular carcinoma（RSHCC） and primary small hepatocellular carrcinoma（PSHCC）. Methods Sixty-five cases of RSHCC（all lesions ≤3 cm） were devided into group B1 with 42 cases of RSHCC（≤2 years）, and group B2 with 23 cases of RSHCC（ 〉2 yeras） and group A invloved 49 cases of PSHCC（all lesions ≤3 cm）. Enhancement patterns in arterial, portal and delayed phase were evaluated respectively in three groups through CEUS and analytic software Sonoliver was applied to obtain quantitative features of CEUS in the region of interest. Receiver operating characteristic（ROC） was drawn and the area under curve（AUC） was calculated. Results CEUS showed hyper-enhancement difference in arterial phase in group B2（72.4%） and group A（94.8%）（P′ = 0.008） showed statistical significance, but no significance was found in enhanced iso in portal phase（P = 0.078）. Hypo-enhancement in the delayed phase in group B2（75.9%）, group A（96.6%） and group B1（95.3%）（P′ = 0.003, P′ = 0.005）. TIC showed HT difference（half time of descending） in B2 group, A group and B1 group（P′ = 0.007, P′ = 0.013） indicated statistical significance but RT, TTP, MTT（P = 0.319,P = 0.104, P = 0.461） showed no difference. AUC was0.841（half time of descending）. Conclusions Enhancement patterns of CEUS（RSHCC） are related to recurrent time. Enhancement patterns of RSHCC（ 〉2 years） is not typical so CEUS should be combined with quantitative analysis of TIC to provide reference for its treatment and prognosis.