超声造影在不同甲胎蛋白表达类型肝细胞癌诊断中的应用价值

Value of contrast-enhanced ultrasound in the diagnosis of HCC with different alpha-fetoprotein types

目的探讨超声造影在不同甲胎蛋白(AFP)表达类型肝细胞癌(HCC)诊断中的应用价值。方法回顾性收集2015年5月至2019年4月淮安市第二人民医院收治的120例HCC患者的临床资料,全部患者均行血清AFP检测及超声、超声造影,所有入选研究对象均经原发性肝癌诊疗规范确诊。依据AFP水平分为AFP阴性组(血清AFP<20μg/L,n=49),AFP阳性组(血清AFP≥20μg/L,n=71)。全部患者检查前空腹,采用彩色多普勒超声诊断仪行常规超声检查及超声造影,记录AFP阳性组与AFP阴性组HCC患者病灶的大小、数目、形态、内部回声及肿瘤侵犯或转移、坏死、出血及超声造影灌注情况。结果AFP阳性组与AFP阴性组HCC患者超声征象差异有统计学意义(P<0.05),与AFP阳性组HCC患者相比,AFP阴性组HCC患者病灶较小、多呈单发、形态较规则、内部回声均匀,坏死、出血及肿瘤侵犯或转移情况较少,以中心血流丰富为主。AFP阳性组HCC患者超声造影主要以"快进快出"为特征,AFP阴性组HCC超声造影主要以"快进慢出"为特征,两组差异有统计学意义(P<0.05)。AFP阴性组HCC患者的达峰时间、开始廓清时间及低增强开始时间为(24.57±4.10)、(40.27±6.39)、(96.34±30.17)s长于AFP阳性组[(20.35±4.26)、(36.15±5.20)、(85.26±24.19)s],差异均有统计学意义(P<0.05)。结论超声造影可定量分析AFP阳性与阴性HCC血流灌注情况,对AFP阴性HCC诊断及预后评估有重要意义。

Objective To investigate the value of contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma(HCC)with different alpha-fetoprotein(AFP)expression types.Methods From May 2015 to April 2019,the clinical data of 120 cases of HCC in the Second People’s Hospital of Huai’an City were retrospectively collected.All patients underwent serum AFP detection,ultrasound and contrast-enhanced ultrasound,so the selected subjects were confirmed by the criteria for diagnosis and treatment of primary hepatocellular carcinoma.According to the level of AFP,they were divided into AFP negative group(serum AFP<20μg/L,n=49)and AFP positive group(serum AFP≥20μg/L,n=71).All patients underwent routine ultrasonography and contrast-enhanced ultrasonography with color Doppler ultrasound diagnostic instrument before fasting examination.The size,number,shape,internal echo,invasion or metastasis,necrosis,hemorrhage and perfusion of positive and negative HCC lesions were recorded.Results There was statistically significant difference between AFP-positive and AFP-negative ultrasound signs of HCC(P<0.05).Compared with AFP-positive HCC,AFP-negative HCC has smaller lesions,more single lesions,more regular shape,more uniform internal echoes,less necrosis,hemorrhage and invasion or metastasis of tumors,mainly with rich central blood flow.AFP-positive group HCC was characterized by fast-in and fast-out,while AFP-negative group HCC was characterized by fast-in and slow-out,the difference was statistically significant(P<0.05).The peak time,clearance time and low enhancement time of AFP-negative group HCC were(24.57±4.10),(40.27±6.39),(96.34±30.17)s,which were longer than those of AFP-negative group HCC[(20.35±4.26),(36.15±5.20),(85.26±24.19)s],the differences were statistically significant(P<0.05).Conclusion Contrast-enhanced ultrasound can quantitatively analyze the blood perfusion of AFP-positive and AFP-negative HCC,which is important for the diagnosis and prognosis evaluation of AFP-negative HCC.