磁共振扩散张量成像鉴别诊断肝内胆管细胞癌与肝细胞癌

目的 探讨磁共振扩散张量成像（DTI）鉴别肝内胆管细胞癌（ICC）和肝细胞癌（HCC）的价值。方法 回顾性分析在我院接受肝脏MR检查并经病理证实的ICC 20例（ICC组）、HCC 32例（HCC组）。所有患者均接受1.5T MRI常规T1WI、T2WI、DWI及DTI序列扫描,观察病变影像学特征。由2名观察者独立测量两组病灶DTI的弥散系数（D）值、各向异性分数（FA）值及DWI的ADC值,分析其测量的一致性并进行组间比较。对有统计学差异的参数,绘制ROC曲线,分析诊断效能及阈值。结果 ICC组9例（9/20,45.00%）病灶边界清晰,HCC组15例（15/32,46.88%）边界清晰,差异无统计学意义（χ²=0.02,P=0.90）。ICC组11例（11/20,55.00%）可见邻近胆管扩张,高于HCC组（4/32,12.50%）,差异有统计学意义（χ²=10.83,P=0.001）。2名观察者测得的2组各参数结果一致性良好,相关系数值均大于0.90。ICC组FA值（0.45±0.16）高于HCC组（0.30±0.13）,差异有统计学意义（P=0.001）;2组的ADC值和D值差异均无统计学意义（P均>0.05）。FA值ROC曲线下面积为0.76,在界值为0.31时,鉴别诊断ICC与HCC的敏感度（85.0%）较高。结论 DTI的FA值对鉴别ICC与HCC有较高的诊断效能,可以为临床提供重要参考。     

IVIM-DWI鉴别诊断肝细胞癌和肝局灶性结节增生

目的 探讨体素内不相干运动扩散加权成像（IVIM-DWI）鉴别肝细胞癌（HCC）与肝局灶性结节增生（FNH）的价值。方法 对407例临床疑似HCC或FNH的患者行常规上腹部MR平扫、动态增强及IVIM-DWI扫描,60例患者（40例HCC,20例FNH）入组。IVIM采用单、双指数模型获得表观扩散系数（ADC）、慢速表观扩散系数（D）、快速表观扩散系数（D^*）及快速扩散成分所占比例（f）。结果 FNH组的ADC、D、D^*及f值分别为（1.60±0.25）×10^-3mm²/s、（1.12±0.17）×10^-3mm²/s、（44.89±18.23）×10^-3mm²/s和（34.80±9.68）%;HCC组分别为（1.32±0.21）×10^-3mm²/s、（0.82±0.21）×10^-3mm²/s、（49.82±20.11）×10^-3mm²/s和（28.72±13.84）%。2组间的ADC、D值差异有统计学意义（P均<0.001）,而D^*、f值差异无统计学意义（P>0.05）。D值相应ROC曲线下面积为0.90,以0.96×10^-3mm²/s为阈值诊断HCC的敏感度、特异度分别为84.44%、90.02%。结论 IVIM-DWI有助于鉴别诊断HCC和FNH,其中双指数模型计算的D值诊断效能更高。     

R2*值预估肝细胞癌病理分级的可行性

目的 探讨增强T2^*加权血管成像（ESWAN）序列的R2^*值预估肝细胞癌（HCC）病理分级的可行性。方法 回顾性分析69例（共71个病灶）接受1.5T MR（含ESWAN序列）检查并经手术病理证实为HCC患者的影像资料,按照病理学分级分为3组,其中低分化组25个,中分化组25个,高分化组21个病灶。由2名观察者分别测量各组HCC实质区的R2^*值,检验2名观察者测量数据的一致性,并分析R2^*值与HCC病理级别的相关性,对不同级别HCC的R2^*值进行组间两两比较;采用ROC曲线评估R2^*值预估低级别HCC的效能并确定界值。结果 2名观察者测量各组数据的一致性很好（ICC>0.75）。R2^*值与HCC病理分级呈弱相关（r_s=0.493,P<0.001）,低、中和高分化组HCC的R2^*值分别为（30.57±9.95）Hz、（21.07±5.11）Hz和（19.08±4.83）Hz,低、中分化组间及低、高分化组间R2^*值差异有统计学意义（P均<0.001）,中、高分化组间差异无统计学意义（P=0.350）。应用R2^*值预估低分化HCC的曲线下面积（AUC）为0.816,以R2^*值=21.96 Hz为界值,敏感度为80.0%,特异度为73.9%。结论 R2^*值可作为MR非强化方式预估低分化HCC的定量指标。     

体素内不相干运动扩散加权成像在肝细胞癌术前分级中的应用

目的 探讨应用体素内不相干运动扩散加权成像(IVIM DWI)对肝细胞癌(HCC)进行术前分级的可行性。方法 回顾性分析29例HCC患者的影像学资料及病理资料。以Edmondson-Steiner分级法为依据分为低级别组、高级别组, 均接受MRI及多b值DWI成像, 应用单双指数函数分别计算两组的标准ADC值、真实扩散系数(D值)、灌注相关扩散系数(D^*值)及灌注分数(f值)。组间比较采用非参数检验Mann-Whitney U, DWI参数预测HCC分级效能的比较采用ROC曲线分析。结果 低级别组12例, 高级别组17例。低级别组标准ADC值、D值、D^*值和f值分别为(1.29±0.27)×10^-3 mm²/s、(1.21±0.36)×10^-3 mm²/s、(40.20±7.79)×10^-3 mm²/s、(23.97±9.22)%, 高级别组分别为(0.90±0.25)×10^-3 mm²/s (0.75±0.20)×10^-3 mm²/s、(53.40±11.99)×10^-3 mm²/s、(32.24±12.66)%, 两组间标准ADC值、D值及D^*值的差异有统计学意义(P均 <0.05), f值差异无统计学意义(P >0.05)。应用标准ADC值、D值、D^*值鉴别诊断低级别与高级别HCC的曲线下面积依次为0.86、0.89、0.83;D值取阈值0.87×10^-3 mm²/s时的敏感度和特异度分别为90.0%和80.0%。结论 应用IVIM DWI可以于术前预测HCC的病理学分级。     

动态X线胸片评估平静呼吸下慢性阻塞性肺疾病患者横膈运动

目的 观察动态X线胸片定量分析平静呼吸下慢性阻塞性肺疾病（COPD）患者横膈运动的价值。方法 对96例COPD患者（COPD组）和50名健康对照者（对照组）行平静呼吸下动态X线胸片检查，经后处理获得横膈运动幅度、速度及时间；记录2组肺功能检查结果，比较组间动态X线胸片及肺功能参数值差异，分析COPD横膈运动参数与肺功能参数的相关性。结果 平静呼吸下COPD组左、右侧横膈运动幅度[（18.63±7.45）mm、（15.64±5.98）mm]均大于对照组[（14.69±5.40）mm、（13.13±4.84）mm，P均<0.05]；吸气时和呼气时COPD组左侧横膈运动速度18.79（15.67，22.67）mm/s、16.00（12.36，21.23）mm/s，右侧为17.00（12.71，19.73）mm/s、13.75（9.50，16.83）mm/s；对照组左侧为15.33（13.96，17.71）mm/s、11.42（9.63，16.00）mm/s，右侧为（14.91±4.38）mm/s、（10.66±3.66）mm/s（P均<0.05）。2组肺功能检查结果差异均有统计学意义（P均<0.01）。COPD组肺功能参数与动态胸片检查各参数均无明显相关（P均>0.05）。结论 动态X线胸片可定量分析COPD患者横膈运动，有望为临床精准评估COPD提供新的手段。     

腺苷负荷动态CT心肌灌注定量评价冠状动脉微循环的实验研究

目的 观察腺苷对心肌灌注的影响，对比腺苷负荷前后心肌灌注变化，并得出定量指标。方法 对10只中华小型猪依次行静息态及负荷态动态CT心肌灌注成像（CT-MPI），测量左心室心肌17个节段、右冠状动脉（RCA）、左前降支（LAD）及回旋支（LCx）3支血管支配心肌，基底部、中间部、心尖部（包括心尖）3个区域及心肌各壁所属节段心肌血流量（MBF）、心肌血容量（MBV）、达峰时间（TTP）及组织通过时间（TTT）。将心肌节段分为静息组和负荷组，比较组间MBF、MBV、TTP及TTT差异。通过腺苷负荷后心肌血流灌注量化指标改变，观察腺苷对冠状动脉微循环的负荷效能。结果 静息组MBF、MBV、TTP及TTT分别为（199.82±66.24）ml/（100 ml·min）、（15.71±5.58）ml/100 ml、（6.38±2.03）s及（13.39±4.91）s；负荷组分别为（278.87±123.24）ml/（100 ml·min）、（20.91±7.66）ml/100 ml、（5.83±1.68）s及（12.53±4.49）s。相比静态组，负荷组MBF、MBV显著升高、TTP缩短（t=8.757、7.738、3.367，P均<0.05），2组TTT差异无统计学意义（t=1.743，P>0.05）。结论 腺苷可增加心肌小型猪血流灌注、缩短灌注TTP；结合动态CT-MPI，可定量分析负荷前后心肌灌注变化及程度。正常心肌组织灌注储备不受腺苷影响。     

双源CT碘浓度及Overlay值诊断不同分化程度胃癌及转移淋巴结

目的 探讨双源CT双能扫描动脉期碘浓度及Overlay值在诊断不同分化程度胃癌及转移淋巴结中的价值。方法 回顾性分析46例术前接受双源CT扫描并经术后病理证实的胃癌伴淋巴结转移患者的资料,测量病灶及转移淋巴结碘浓度、Overlay值。根据病理分化程度将胃癌病灶及转移淋巴结分为分化良好组（病理结果为高分化、中高分化、中分化）与分化不良组（病理结果为中低分化、低分化）。采用独立样本t检验比较2组间胃癌及转移淋巴结碘浓度、Overlay值;并绘制ROC曲线,评价其诊断不同分化程度胃癌及转移淋巴结的效能。结果 46例胃癌病灶中分化良好组15例,分化不良组31例;73枚转移淋巴结中分化良好组24枚,分化不良组49枚。分化不良组胃癌、转移淋巴结碘浓度为（2.12±0.72）mg/ml和（1.85±0.67）mg/ml,Overlay值为（37.32±13.18）HU和（32.24±12.10）HU,均高于分化良好组（P均<0.05）。动脉期碘浓度及Overlay值诊断胃癌分化程度的AUC分别为0.799、0.745（P=0.001、0.008）,诊断转移淋巴结分化程度的AUC分别为0.787、0.733（P<0.001、P=0.001）。结论 动脉期碘浓度及Overlay值对诊断不同分化程度胃癌及转移淋巴结有一定价值,可为术前评估其分化程度提供依据。     

DWI定量测量诊断宫颈癌

目的 探讨DWI定量测量诊断宫颈癌的价值。方法 收集经手术病理证实为宫颈癌的患者93例,包括鳞癌66例(高分化1例,中分化56例,低分化9例)及腺癌27例(高分化3例,中分化21例,低分化3例),宫颈正常者20例。对所有受检者均行常规MR及DWI扫描,测量ROI的ADC值,并进行统计学分析。结果 宫颈癌的ADC值[(1.05±0.24)×10^-3 mm²/s]低于正常宫颈[(1.87±0.22)×10^-3 mm²/s;t=-14.08,P<0.05]。宫颈鳞癌的ADC值[(0.97±0.13)×10^-3 mm²/s]低于宫颈腺癌[(1.26±0.31)×10^-3 mm²/s;t=-4.79,P<0.05]。中分化宫颈鳞癌ADC值[(0.98±0.14)×10^-3 mm²/s]高于低分化宫颈鳞癌[(0.88±0.14)×10^-3 mm²/s;t=2.31,P<0.05]。以ADC<1.59×10^-3 mm²/s诊断宫颈癌时,敏感度为95.70%,特异度为100%。结论 DWI对宫颈癌的诊断具有较高价值,ADC值可鉴别宫颈鳞癌与宫颈腺癌,且可评价宫颈鳞癌的分化程度。     

弥散张量成像诊断新生儿和婴儿胆道闭锁

目的 探讨弥散张量成像（DTI）对新生儿和婴儿胆道闭锁（BA）的诊断价值。方法 收集疑诊为BA或其他胆道疾病的患儿46例,以手术探查、腹腔镜探查、术中造影、病理检查或临床治疗结果作为金标准,将患儿分为BA组与非BA组（non-BA组）。对所有患儿应用1.5T MR扫描仪,采用单次激发自旋回波平面成像DTI序列（b值为1000 s/mm²）行肝脏扫描,经后处理获得平均扩散系数（AvgDC）图及FA图,测量AvgDC值及FA值。结果 46例中,BA组24例,non-BA组22例,BA组的AvgDC值显著低于non-BA组［（1.27±0.16）×10^-3 mm²/s vs （1.43±0.15）×10^-3 mm²/s,P=0.001)］。在BA组中,不同肝脏纤维化分级患儿间AvgDC值、FA值的差异均无统计学意义（P>0.05）;INF1~INF3级炎症分级患儿AvgDC值逐渐降低,但差异无统计学意义（F=2.15, P=0.14）,FA值差异有统计学意义（F=5.51, P=0.01）。应用AvgDC、FA值诊断BA的ROC曲线下的面积分别为0.80±0.07、0.60±0.09;AvgDC界限值为1.33×10^-3 mm²/s时,诊断敏感度为75.00%（18/24）,特异度为77.27%（17/22）。结论 DTI的AvgDC值可用于诊断新生儿和婴儿BA,但其诊断敏感度与特异度仍有待提高。     

个体化注射对比剂软件P3T-PA在CT肺动脉成像中的应用

目的 评估采用个体化对比剂注射软件P3T-PA进行CT肺动脉成像（CTPA）的可行性。方法 将80例临床疑似肺动脉栓塞行CTPA检查患者按随机表分为两组：P3T组（n=40）,采用P3T-PA个性化对比剂注射软件,常规组（n=40）,采用常规对比剂注射方案。测量各级肺动脉（肺动脉主干、左肺动脉、右肺动脉、左下肺动脉基底支、右下肺动脉基底支）CT值及CT值标准差（SD）、左心房CT值（LACTv）,计算肺动脉主干（MPACTv）CT值与LACTv差值（MPACTv－LACTv）及两下肺动脉基底支SNR、CNR,记录对比剂注射流速、用量及扫描延迟时间,并进行统计学分析。结果 两组各级肺动脉CT值、SD值、MPACTv－LACTv及两下肺动脉基底支SNR、CNR差异均无统计学意义（P均>0.05）;P3T组和常规组对比剂注射流速、扫描延迟时间差异无统计学意义;[（4.76±0.50）ml/s vs（4.69±0.40）ml/s,P=0.521;（13.18±1.81）s vs（14.15±4.38）s,P=0.198];P3T组对比剂用量较常规组少[（37.93±3.86）ml vs（49.27±6.76）ml,P<0.001]。结论 采用P3T-PA个体化对比剂注射软件行CTPA检查,操作简便,可精确计算对比剂用量,对比剂用量减少且图像质量良好。     

Utility of Contrast-enhanced Ultrasonography with Perflubutane for Determining Histologic Grade in Hepatocellular Carcinoma

The purpose of this study was to clarify the diagnostic value of contrast-enhanced ultrasonography (CEUS) with perflubutane in determining the histologic grade in hepatocellular carcinoma (HCC). A total of 147 surgically resected HCCs were dichotomized as well differentiated HCC (wd-HCC) and moderately- or poorly-differentiated HCC (mp-HCC). CEUS findings were evaluated during the arterial phase (vascularity, level and shape of enhancement), portal phase (presence or absence of washout) and post-vascular phase (echo intensity and shape). Receiver operating characteristic (ROC) curve analysis for the diagnosis of mp-HCC yielded area under the ROC curve (A_z) values for arterial phase vascularity and portal phase washout of 0.910 and 0.807, respectively. The A_z value for the combination of vascularity and washout for the diagnosis of mp-HCC was 0.956 (95% confidence interval, 0.910–0.979), corresponding to high diagnostic value. In conclusion, CEUS can provide high-quality imaging assessment for determining the histologic grade of HCCs.     

The Degree of Contrast Washout on Contrast-Enhanced Ultrasound in Distinguishing Intrahepatic Cholangiocarcinoma from Hepatocellular Carcinoma

We aim to assess the role and degree of contrast washout in the differential diagnosis of intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) on contrast-enhanced ultrasound (CEUS). Fifty-six histopathology-confirmed ICC nodules and 184 HCC nodules were included in this study. The nodules' washout degree on CEUS at 1, 2 and 3 min was semi-quantitatively and qualitatively assessed using gray-scale video signal intensity. Semi-quantitative assessment showed that the washout degree of ICCs at 1, 2 and 3 min were significantly lower than those of HCCs (p < 0.001) and similar results were found in the same size range subgroups. There were no significant differences in the washout degree of ICCs between patients with chronic hepatitis and those without. The areas under receiver operating characteristic curves, using the nodules' washout degree at 1, 2 and 3 min to differentiate ICC from HCC, were 0.957, 0.979 and 0.982, respectively. The qualitative assessment showed the washout of ICCs was more rapid and obvious than that of HCCs. At 3 min, moderate and marked washout were observed in all ICCs, but in only 12.5% HCCs (p < 0.001). In conclusion, ICCs displayed much higher degree of contrast washout than HCCs on CEUS, which allowed for differentiation from HCCs.     

肝细胞肝癌超声造影增强模式对分化程度的诊断价值

  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。     

超声造影定量分析鉴别富血供转移性肝癌与肝细胞肝癌

目的 探讨CEUS定量分析在鉴别诊断富血供转移性肝癌与肝细胞癌(HCC)中的作用。 方法 回顾分析经病理证实的25例富血供转移性肝癌及 82例HCC患者资料,对其CEUS结果进行比较和定量分析。 结果 富血供转移性肝癌的流出时间(WT)为(26.59±9.34)s,增强持续时间(EDT)为(10.60±3.58)s,HCC的WT为(61.99±50.97)s,EDT为(46.42±50.45)s,差异均有统计学意义(t=3.93、-3.54,P均<0.01)。以WT为28.5 s及EDT为15.5 s区分转移性肝癌与HCC,约登指数最大,敏感度和特异度分别为87.36%、75.01%,85.37%、92.03%。富血供转移性肝癌及HCC在造影剂到达时间、达峰时间等方面差异无统计学意义。 结论 根据定量分析参数WT和EDT,CEUS可以简便、无创地对富血供转移性肝癌和HCC进行鉴别诊断。     

肝细胞肝癌超声造影增强模式对分化程度的诊断价值简

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”,2l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（X2=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。     

原发性肝细胞癌超声造影表现与微血管密度的相关性

目的 探讨原发性肝细胞癌(HCC)的造影增强时间-强度曲线参数与肿瘤微血管密度(MVD)的相关性. 方法 回顾性分析经病理证实为HCC的24例患者HCC超声造影增强时间-强度曲线参数(增强时间、上升斜率、相对峰值强度、峰值增强率、下降斜率),同时检测肿瘤的MVD,分析造影增强时间-强度曲线参数与MVD的相关性. 结果 中低分化HCC组MVD大于高分化HCC组(P<0.05).HCC的相对峰值强度、下降斜率与MVD计数相关(P<0.05),相关系数分别为0.44、0.50. 结论 HCC造影增强时间-强度曲线的相对峰值强度、下降斜率可反映肿瘤微血管形成,不同分化程度HCC的MVD差异显著.     

Contrast-enhanced sonography in the diagnosis of small hepatocellular carcinoma < or =2 cm

PURPOSE: To evaluate the usefulness of contrast-enhanced sonography (CEUS) in the diagnosis of small hepatocellular carcinoma (HCC) measuring < or =2 cm in diameter. METHODS: We identified 104 focal liver lesions measuring < or =2 cm in 104 consecutive patients who were enrolled for baseline sonography (BUS) and CEUS examination (49 HCCs, 55 non-HCCs). A real-time, contrast-specific mode of contrast pulse sequencing and a sulphur hexafluoride-filled microbubble contrast agent were used for CEUS. The diagnostic performances of BUS and CEUS in differentiating focal liver lesions (HCC or non-HCC) were analyzed and compared. RESULTS: On CEUS, 43 (87.8%) of the 49 HCC lesions were hyperenhanced, 5 (10.2%) were isoenhanced, and 1 (2%) was hypoenhanced during the arterial phase when compared with adjacent liver tissue. Thirty-nine (79.6%) HCCs exhibited washout from the portal phase to the late phase. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy before and after contrast agent administration were 28.6% (14/49) versus 79.6% (39/49) (p < 0.001), 94.5% (52/55) versus 92.7% (51/55) (p > 0.05), 82.4% (14/17) versus 90.7% (39/43) (p > 0.05), 59.8% (52/87) versus 90.7% (39/43) (p < 0.01), and 63.5% (66/104) versus 86.5% (90/104) (p < 0.001), respectively. No significant difference in diagnostic performance of CEUS was found between lesions measuring < or =1.5 cm and those 1.6-2 cm and between lesions located at a depth of < or =6 cm from the skin and those located deeper. CONCLUSIONS: CEUS significantly improved the diagnostic performance in characterization of small HCCs < or =2 cm compared with BUS.     

Detection of hepatocellular carcinoma capsule by contrast-enhanced ultrasound using Levovist: correlations with pathological findings

Purpose To determine the most appropriate therapy for each hepatocellular carcinoma (HCC) nodule, it is important to ascertain whether the tumor has a capsule. The aim of this study was to investigate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in HCC capsule detection by comparing ultrasound findings with histological results from operative specimens. Methods Thirty-six HCC nodules (all smaller than 5 cm) from 36 patients who had undergone hepatectomy were examined by CEUS using Levovist with agent detection imaging. The vascular phase images and time course changes of HCC were observed after a bolus injection of Levovist. We classified the appearance of the tumor artery, tumor enhancement, and washout into several patterns. We grouped HCCs into encapsulated or nonencapsulated on the basis of the histology of the operative specimens, taking into account the effectiveness of transcatheter arterial chemoembolization. Ultrasound and pathological findings were compared to assess the ability of CEUS to detect HCC capsules. Results During the arterial phase, 12 (80.0%) encapsulated and 3 (14.3%) nonencapsulated HCC nodules showed a surrounding artery with branches pattern (P < 0.0001). The sensitivity, specificity, and accuracy of this pattern for HCC capsule detection were 80%, 86%, and 83%, respectively. A branching artery was found in 15 (71.4%) nonencapsulated but in only 3 (20.0%) encapsulated HCC nodules (P < 0.01). The sensitivity, specificity, and accuracy of this branching artery pattern for confirming the absence of a capsule in HCC nodules were 71%, 80%, and 75%, respectively. Almost all HCC nodules showed strong–moderate or weak enhancement and strong–moderate or mild washout. Neither enhancement nor washout pattern correlated with the presence of a capsule. Conclusion The arterial phase of CEUS is very useful for detection of HCC capsules and therefore facilitates selection of the most appropriate treatment method for HCC.     

Contrast-Enhanced Ultrasound Patterns for the Non-invasive Diagnosis of Hepatocellular Carcinoma: A Prospective Multicenter Study in Histologically Proven Liver Lesions in a Real-Life Setting Demonstrating the Benefit of Extended Late Phase Observation

The hallmark for the non-invasive diagnosis of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS) in cirrhosis is arterial phase hyperenhancement (APHE), followed by late-onset (>60 s), mild washout. Large retrospective studies report this pattern of washout to occur in the vast majority of HCCs. However, a prospective multicenter validation of these findings is still missing. Thus, we initiated a prospective multicenter validation study assessing CEUS enhancement patterns in focal liver lesions of patients at risk for HCC. We analyzed lesions that were eventually histology proven in a real-life setting. CEUS patterns were assessed for subgroups of HCC, intrahepatic cholangiocellular carcinoma (iCCA) and non-HCC, non-iCCA lesions. The diagnosis was HCC in 316 lesions (median size: 40 mm), iCCA in 26 lesions (median size: 47.5 mm) and non-HCC, non-iCCA in 53 lesions (median size: 27 mm). Overall, 85.8% of HCCs exhibited APHE. APHE followed by washout occurred in 72.8% of HCCs and 50% of iCCAs and non-HCC, non-iCCA malignancies (p < 0.05). Early and marked washout was associated more commonly with iCCA; HCCs exhibited mostly late and mild washout (onset >4–6 min in 10% of cases). Our prospective data confirm that the typical pattern of APHE followed by late-onset, mild washout occurs in the majority of HCCs.     

原发性肝细胞癌的超声造影表现与血管内皮生长因子表达的相关性

目的探讨原发性肝细胞癌(HCC)的CEUS增强时间-强度曲线各参数与血管内皮生长因子(VEGF)表达的相关性。方法选择经手术病理证实的27例原发性HCC作为研究对象,其中中低分化癌16例,高分化癌11例,取其中13例患者的癌周组织作为对照。分析术前CEUS图像,绘制时间-强度曲线,计算增强时间、上升斜率、相对峰值强度、峰值增强率、下降斜率。应用S-P免疫组化法对VEGF进行定位,应用蛋白印迹法对VEGF进行定量,分析CEUS曲线参数与VEGF表达的相关性。结果 VEGF蛋白主要分布于胞浆中,蛋白定量分析显示中低分化HCC、高分化HCC、对照组织的VEGF蛋白相对含量分别为(46.63±9.70)%、(32.36±8.56)%、(8.85±5.05)%,两两比较差异均有统计学意义(P均<0.05)。HCC曲线的相对峰值强度与VEGF蛋白相对含量呈正相关(r=0.56,P<0.05),而增强时间、上升斜率、峰值增强率及下降斜率与VEGF蛋白相对含量均无相关性(P均>0.05)。结论 HCC造影增强时间-强度曲线的相对峰值强度可反映VEGF蛋白表达,不同分化程度HCC的VEGF蛋白相对含量差异显著。