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Contrast-enhanced Ultrasound of Hepatocellular Carcinoma: Enhancement Pattern Features for Evaluation of Tumor Differentiation
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摘要:
目的 探讨肝细胞肝癌的超声造影增强模式对于分化程度的诊断价值。 方法 回顾性分析81例手术病理证实的肝细胞肝癌患者的超声造影特点。将动脉期病灶内部开始增强、门脉期回声低于周边肝实质的增强模式定义为"快进快出"型; 将动脉期病灶内部开始增强、延迟期回声低于周边肝实质的增强模式定义为"快进慢出"型。根据病理结果将肝细胞肝癌分为高分化及中低分化两组。总结分析增强模式对于分化程度的诊断价值。 结果 81例肝细胞肝癌患者中, 高分化肝细胞肝癌38例, 中低分化者43例。17例(21.0%)高分化肝细胞肝癌超声造影表现为"快进慢出", 21例(25.9%)高分化肝细胞肝癌表现为"快进快出", 43例(53.1%)中低分化肝细胞肝癌表现为"快进快出"。"快进慢出"的增强模式在高分化肝细胞肝癌组较中低分化肝细胞肝癌组患者中更为常见(χ2=24.35, P < 0.01)。"快进慢出"的增强模式诊断高分化肝细胞肝癌的敏感性44.7%, 特异性100%, 阳性预测值100%, 阴性预测值67.2%, 准确率74.1%。 结论 超声造影"快进慢出"模式对提示及诊断高分化肝细胞肝癌可能有帮助。 Abstract:Objective To investigate the enhancement pattern features of hepatocellular carcinoma(HCC) on contrast-enhanced ultrasound (CEUS) and explore the diagnostic value of CEUS for predicting tumor differentiation. Methods CEUS features of 81 cases of pathologically confirmed HCC were retrospectively analyzed. The enhancement pattern was defined as "quick in-quick out" when the lesion was enhanced in arterial phase and showed as hypoechoic in portal phase; when the lesion was enhanced in arterial phase and showed as hypoechoic in late phase, the enhancement pattern was defined as "quick in-slow out". According to the final pathological results, HCCs were categorized into well-differentiated group and poorly-to-moderately differentiated group. The diagnostic value of CEUS for the HCC differentiation was summarized. Results Of these 81 HCC patients, 38 were diagnosed as well-differentiated HCCs and 43 as poorly-to-moderately differentiated HCCs. The enhancement pattern was "quick in-slow out" in 17 patients (21.0%, 17/81) with well-differentiated HCCs, "quick in-quick out" in 21 patients (25.9%, 21/81)with well-differentiated HCCs, and "quick in-quick out" in 43 patients (53.1%, 43/81) with poorly-to-moderately differentiated HCCs. The "quick in-slow out" pattern was more common in the well-differentiated HCC group than in the poorly-to-moderately differentiated HCC(χ2=24.35, P < 0.01).Its diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were 44.7%, 100%, 100%, 67.2%, and 74.1%, respectively. Conclusion The "quick in-slow out" enhancement pattern may be helpful for predicting and diagnosing the well-differentiated HCC. -
Key words:
- contrast-enhanced ultrasound /
- hepatocellular carcinoma /
- differentiation
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图 1 64岁男性高分化肝细胞肝癌患者超声造影表现为“快进慢出”增强模式(箭头所示为肿瘤)
A.动脉期(24 s)不均匀快速增强；B.延迟期(4 min 19 s)廓清呈低回声
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