肝癌超声造影特征及与临床分期、微血管侵犯的相关性研究

Contrast-enhanced ultrasound features of hepatocellular carcinoma and their relationship with clinical staging and microvascular invasion

目的分析肝癌超声造影特征及与临床分期、微血管侵犯(MVI)的相关性。方法回顾性收集2022年1月至2023年1月浙江省医疗健康集团衢州医院就诊的125例肝癌患者临床资料。所有患者均行超声造影检查和病理检查,比较患者病灶区与肝实质区超声造影时间信号曲线(TIC)参数、不同临床分期超声造影TIC参数、MVI阳性与MVI阴性患者超声造影TIC参数,分析肝癌患者超声造影TIC参数与临床分期、MVI的的相关性。结果病灶区达峰时间、持续时间、廓清时间均明显低于肝实质区,而达峰强度明显高于肝实质区(均P<0.05);Ⅰ期、Ⅱ期、Ⅲ期持续时间、廓清时间及达峰强度差异均有统计学意义(均P<0.05),且Ⅰ期、Ⅱ期持续时间、廓清时间均明显高于Ⅲ期,达峰强度均明显低于Ⅲ期(均P<0.05),Ⅰ期持续时间、廓清时间明显高于Ⅱ期,达峰强度明显低于Ⅱ期(均P<0.05);MVI阳性组持续时间、廓清时间均明显低于MVI阴性组,达峰强度明显高于MVI阴性组(均P<0.05);MVI阳性组Ⅱ期、Ⅲ期患者分别33例和17例,其中Ⅱ期持续时间、廓清时间均高于Ⅲ期,而达峰强度低于Ⅲ期(均P<0.05);MVI阴性组Ⅰ期、Ⅱ期患者分别61例和14例,其中Ⅰ期持续时间、廓清时间均高于Ⅱ期,而达峰强度则低于Ⅱ期(均P<0.05);Spearman秩相关分析显示,肝癌患者超声造影的达峰时间、持续时间、廓清时间与临床分期均呈负相关,达峰强度与临床分期呈正相关(均P<0.05);肝癌患者超声造影的达峰时间、持续时间、廓清时间与MVI阳性均呈负相关,达峰强度与MVI阳性呈正相关(均P<0.05)。结论肝癌超声造影特征与临床分期、MVI具有一定相关性,可为临床分期及MVI评估提供诊断信息。

Objective To investigate the contrast-enhanced ultrasound features of hepatocellular carcinoma(HCC),and their relationship with clinical staging and microvascular invasion(MVI).Methods The medical records of 125 patients with pathologically confirmed HCC in Quzhou Hospital of Zhejiang Medical and Health Group from January 2022 to January 2023 were retrospectively reviewed.All patients underwent contrast-enhanced ultrasonography.The time-signal intensity curve(TIC)parameters were compared between focal area and liver parenchyma;and the correlation of TIC parameters with clinical stage and MVI in HCC patients was analyzed.Results The time to peak,duration,and wash-out time in HCC were significantly shorter,the peak intensity was significantly higher than those in liver parenchyma(all P<0.05).There were significant differences in duration,clearance time and peak intensity between stageⅠ,ⅡandⅢHCC,and the duration and wash-out time in stageⅠand stageⅡHCC were significantly longer,the peak intensity was significantly lower than those in stageⅢHCC(all P<0.05).The duration and wash-out time in stageⅠHCC were significantly longer,while the peak intensity was significantly lower than those in stageⅡHCC(all P<0.05).The duration and wash-out time of patients with positive MVI were significantly shorter,and the peak intensity was significantly higher than those with negative MVI(all P<0.05).In MVI positive patients,the duration and clearance time of the stageⅡpatients(n=33)were significantly higher,while the peak intensity was lower than those of stageⅢpatients(n=17)(all P<0.05).In patients with negative MVI,the duration and clearance time of the stageⅠgroup(n=61)were significantly higher,while the peak intensity was lower than those of the stageⅡpatients(n=14)(all P<0.05).Spearman correlation analysis found that the time to peak,duration and wash-out time of contrast-enhanced ultrasound were negatively correlated with clinical stage,and peak intensity was positively correlated with clinical stage in HCC patients(all P<0.05).The time to peak,duration and wash-out time of contrast-enhanced ultrasound were negatively correlated with MVI positivity,and peak intensity was positively correlated with MVI positivity in HCC patients(all P<0.05).Conclusion The contrast-enhanced ultrasound features of HCC patients are correlated to clinical stage and MVI,which provides information for clinical staging and MVI evaluation.