不同病理分型混合型肝癌的超声造影特征分析

Analysis of contrast-enhanced ultrasound features of mixed hepatocellular carcinoma with different pathological types

目的:观察混合型肝癌(CHC)的临床及超声造影特征,并探讨不同病理分型CHC的超声造影表现差异。方法:回顾性分析经手术病理确诊为CHC患者的临床病理及超声图像,总结其超声造影特征并对不同病理分型CHC的超声造影表现进行比较。结果:共纳入49例CHC患者,其中经典型27例,以HCC成分为主型21例,以ICC成分为主型25例,HCC与ICC比例相等型3例。灰阶超声表现:CHC病灶内部以低回声为主(79.6%),多表现为边界不清、形态不规则的实质性肿块。超声造影表现:20例(40.8%)CHC病灶动脉期增强方式为整体均匀增强,23例(46.9%)整体不均匀增强,6例(12.2%)环状增强;26例(53.1%)表现为显著消退,16例(32.7%)为轻度消退。以肝细胞肝癌(HCC)成分为主的病灶多表现为整体均匀(57.1%,12/21)或不均匀增强(42.9%,9/21),而以肝内胆管细胞癌(ICC)为主要成分的病灶多呈整体不均匀增强(48.0%,12/25)或环状增强(24.0%,6/25)。经典型CHC病灶平均消退时间短于伴干细胞特征型CHC(P<0.05),两者其余超声造影表现差异无统计学意义。结论:CHC超声造影表现与病理分型有关,不同细胞成分CHC病灶超声造影增强模式存在差异,经典型CHC与伴干细胞特征型CHC造影剂消退时间存在差异。

Objective:To investigate the contrast-enhanced ultrasound(CEUS)imaging features of combined hepatocellular carcinoma(CHC)and to explore the differences in the CEUS images of different pathological types of CHC.Methods:The pathological and ultrasound images of patients with pathological-confirmed CHC were retrospectively analyzed.CEUS features were summarized and compared between different pathological types of CHC.Results:A total of 49 CHC patients were enrolled,including 27 cases of classic type and 22 cases with stem cell characteristics.There were 21 cases with HCC component as the main type,25 cases with ICC component as the main type,and 3 cases with the same ratio of HCC and ICC.On gray-scale ultrasound,the interior of CHC lesions was mainly hypoechoic(79.6%),most of which presented as solid masses with unclear boundary and irregular shape.On CEUS,the enhancement patterns in the arterial phase of CHC lesions were overall uniform enhancement in 20 cases(40.8%),overall non-uniform enhancement in 23 cases(46.9%),and annular enhancement in 6 cases(12.2%).Significant attenuation was observed in 26 cases(53.1%)and mild resolution was observed in 16 cases(32.7%).The lesions mainly composed of hepatocellular carcinoma(HCC)were generally uniform(57.1%,12/21)or inhomogeneous enhancement(42.9%,9/21),while those mainly composed of intrahepatic cholangiocarcinoma(ICC)were generally inhomogeneous enhancement(48.0%,12/25)or annular enhancement(24.0%,6/25).The average attenuation time of classic CHC lesions was earlier than that of stem cell-associated CHC(P<0.05),and there was no significant difference between the other CEUS findings of the two groups.Conclusions:There are differences in CEUS patterns of CHC lesions with different cell components.Attenuation time between classical CHC and CHC with stem cell characteristics is statisticallydifferent.CEUS is correlated with pathological characteristics of CHC.