肝细胞癌螺旋CT增强表现特征与微血管形成的关系研究

目的　探讨肝细胞癌 (hepatocellularcarcinoma ,HCC)的血管形成情况以及双期螺旋CT (spiralcomputedtomography ,SCT)增强表现特征与HCC微血管形成、其它临床和病理特征之间的关系。方法　对 5 0例 (男 3 9例 ,女 11例 )共 5 4个经手术病理证实且行SCT动、静脉双期增强扫描的HCC病灶进行回顾性分析 ,用免疫组化SP法检测癌组织血管形成情况 ,将SCT的表现特征与免疫组化结果和其它的临床、病理特征进行对照分析。结果　第Ⅷ因子相关抗原 (FⅧRA)表达部位以间质内皮细胞为主的占2 4.1% ( 13 /5 4) ,以肝窦内皮为主的占 18.5 % ( 10 /5 4) ,混合型占 5 7.4% ( 3 1/5 4)。所有病灶平均微血管密度 (microvesseldensity ,MVD)为 5 2 .2 0± 13 .89,微血管的平均直径为 ( 15 .0 6± 7.76) μm。MVD与Edmondson分级有关 (F =3 .488,Ρ =0 .0 2 3 ) ;微血管直径与AFP值有关 (t =3 .3 0 3 ,Ρ =0 .0 0 2 )。与SCT显示的包膜类型有关的是MVD和病理分级 ;与增强类型有关的是肿瘤的大小和瘤内有无坏死 ;与SCT显示的侵袭转移性有关的是MVD、FⅧRA的表达部位和肿瘤的大小 ;与SCT显示的病灶的大小有关的是AFP值 ;与SCT显示的肝硬化有关的是HBsAg和病灶的大小。 结论　微血管形成决定HCC的某些生物学行为 ,SCT图像表现特     

肝细胞癌双期螺旋CT表现特征与VEGF、bFGF表达以及临床、病理的关系研究

目的 探讨肝细胞癌(HCC)双期螺旋CT(SCT)增强表现特征与血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)的表达以及临床、病理特征之间的关系。资料与方法 对50例共54个经手术病理证实且行SCT动、静脉双期增强扫描的HCC病灶进行回顾性分析，记录其临床和病理特征，用免疫组织化学SP法检测癌组织中VEGF、bFGF的表达情况，将SCT表现特征与上述指标进行对照分析。结果 HCC中VEGF和bFGF的阳性表达率分别为81.5％(44／54)和75．9％(41／54)。Logistic回归分析表明与SCT显示的包膜类型有关的因素是病理分级；与强化类型有关的因素有病灶的大小和瘤内有无坏死；与SCT显示侵袭转移性有关的因素是病灶的大小；与SCT显示的病灶大小有关的因素有AFP水平、VEGF和病理分级。结论 HCC的SCT表现特征受多种不同因素的共同影响，SCT表现特征可在一定程度上反映VEGF的表达情况。     

肝细胞癌SCT表现特征与p21WAF1、p16INK4、Rb关系的研究

目的：探讨HCC SCT表现特征与癌细胞中p21^WAF1、p16^INK4、Rb表达的关系。方法：对39例（41例病灶）经手术病理证实且行SCT动、静脉双期增强扫描的HCC病例，观察每个癌灶的SCT表现特征：肿瘤的大小、包膜、侵袭危险性、强化类型和肝硬化情况。用免疫组织化学的方法检测癌组织中p21^WAF1、p16^INK4、Rb的表达情况。分析评价SCT表现 特征与这三种蛋白之间的关系。结果：SCT图像上HCC肿瘤大小、侵袭危险性、强化类型分别与p21蛋白、p16蛋白表达之间有相关性（P＜0.05)，HCC包膜形成状态和癌灶周围组织有无肝硬化与p21蛋白、p16蛋白表达之间无相关性（P＞0.05)。HCC SCT表现特征与Rb蛋白之间无统计学意义（P＞0.05)。结论：HCC的SCT表现与p21^WAF1、p16^INK4表达存在较为密切的相关关系，根据HCC的SCT表现特征（肿瘤大小、侵袭危险性、强化类型），可在一定程度上预测p21^WAF1、p16^INK4表达情况，有助于HCC的早期诊断及治疗方案的选择。     

肝细胞癌SCT表现特征与p21WAF1、p16INK4、PCNA关系的研究

目的探讨肝细胞癌(HCC)螺旋CT(SCT)表现特征与癌细胞中p21WAF1、p16INK4及PCNA表达的关系. 资料与方法对39例(共41个病灶)经手术病理证实且行SCT动、静脉双期增强扫描的HCC患者,观察每个病灶SCT表现特征,包括肿瘤大小、包膜的形成、侵袭危险性及强化类型.用免疫组织化学方法检测癌组织中p21WAF1、p16INK4、PCNA的表达情况.分析评价SCT表现特征与这3种蛋白之间的关系. 结果 SCT图像上HCC肿瘤大小、侵袭危险性、强化类型分别与p21蛋白、p16蛋白及PCNA有相关性(P＜0.05),HCC包膜形成与p21蛋白、p16蛋白及PCNA无相关性(P＞0.05). 结论根据HCC的SCT表现特征(肿瘤大小、侵袭危险性、强化类型),可在一定程度上推测p21WAF1、p16INK4及PCNA表达情况,有助于HCC的早期诊断及治疗方案的选择.     

肝细胞癌SCT表现特征与血管生成及TP和TGF-β1表达的相关性研究

目的探讨肝细胞癌(HCC)螺旋CT(SCT)增强表现特征与TP、TGF-β1及微血管密度(MVD)之间的相关性.方法对47例经手术病理证实且行SCT动、静脉双期增强扫描的HCC病灶进行回顾性分析,观察其SCT表现特征,包括肿瘤大小、包膜、子灶、门静脉癌栓、肝门淋巴结转移和强化类型等.用免疫组织化学方法检测癌组织中TP、TGF-β1和CD34的表达情况.分析评价SCT表现特征与3种因子之间的关系.结果TP及MVD与SCT图像上的高侵袭性、包膜有关(P＜0.05).TGF-β1与高侵袭性有关(P＜0.05).3种因子的表达均与肿瘤大小、强化类型无明显相关性(P＞0.05).结论根据HCC的SCT表现特征可在-定程度上反映HCC微血管生成以及TP、TGF-β1的表达情况.     

肝细胞癌肿瘤血管生成与螺旋CT增强特征探讨

目的　探讨肝细胞癌 (HCC)肿瘤血管生成的调控因子血管内皮生长因子 (VEGF)及血管内皮生长因子受体 (VEGFR)表达及其与螺旋CT(SCT)增强表现和特征之间的相关性。资料与方法　对经手术病理证实的 39例共4 1个HCC病灶 ,观察其SCT表现和特征。用免疫组织化学SP法检测HCC中VEGF、VEGFR 1/Flt 1和VEGFR 2 /KDR/Flk 1蛋白的表达 ,并与SCT增强表现和特征对照。结果　VEGF、Flt 1、KDR/Flk 1阳性率分别为 6 1.0 %、6 8.3%和 70 .7% ;在侵袭高危组、包膜欠完整和 /或无包膜组、小肝癌组中VEGF和KDR/Flk 1的表达均高于侵袭低危组、包膜完整组和大肝癌组 ,差异有显著性 (P <0 .0 5 ) ;但VEGF和KDR/Flk 1的表达与动脉期强化类型之间无相关性。Flt 1的表达在各组间无显著性差异。χ2 检验提示VEGF表达与KDR/Flk 1表达相关 (P <0 .0 0 1) ,而未显示VEGF表达与Flt 1表达、KDR/Flk 1表达与Flt 1表达之间的相关性 (P >0 .0 5 )。结论　VEGF通过结合其特异性酪氨酸激酶受体KDR/Flk 1促进HCC肿瘤血管生成因而促进HCC的生长、浸润和转移 ;且可通过SCT增强表现在一定程度上推测VEGF及其受体KDR/Flk 1和Flt 1的表达情况。     

肝细胞癌和胆管细胞癌螺旋CT增强表现与VEGF表达及MVD的相关性研究

目的探讨肝细胞癌(HCC)及胆管细胞癌(CCC)螺旋CT(SCT)增强表现特征与它们的血管内皮生长因子(VEGF)蛋白表达水平、微血管密度(MVD)的关系。方法回顾性分析经手术病理证实且术前行SCT增强检查的50例HCC(共54个病灶)和24例CCC(共28个病灶),观察其SCT增强表现类型及二者动脉期增强程度,用免疫组化SP法检测肿瘤VEGF组织的表达水平,用CD34标记微血管染色,进行MVD计数。对二者的SCT增强表现类型与VEGF表达、MVD进行统计学对照分析。结果(1)HCC和CCC肿瘤组织VEGF阳性表达率及MVD方面的差异均具有显著性(2χ=5.50,t=2.03,P<0.05);(2)HCC中动脉期强化类型与VEGF和MVD未显示出相关性(2χ=1.95,t=1.80,P>0.05);CCC中不同延迟强化类型病灶的MVD值差异具有显著性(t=2.09,P<0.05);(3)HCC和CCC病灶动脉期增强程度具有显著性差异(2χ=46.6,P<0.01)。结论HCC和CCC的VEGF蛋白表达率及MVD方面的差异在一定程度上影响了二者SCT图像增强表现情况。     

肝细胞癌CT表现与nm23-H1基因和CD44v6基因表达的研究

目的 探讨螺旋CT双期扫描对推测肝细胞癌(HCC)细胞中nm23-H1基因和CD44v6基因表达价值。材料与方法 36例经手术病理证实且行螺旋CT(SCT)双期增强扫描的HCC病例,观察其SCT表现特征:包膜、子灶、门静脉癌栓、肝门淋巴结转移、肝硬化、肿瘤的大小和强化特征。用免疫组织化学方法检测癌组织中nm23-H1基因和CD44v6基因表达情况。结果 HCC细胞中,nm23-H1阳性21例,阳性率为58.3％,转移高危组(子灶、门静脉癌栓、肝门淋巴结转移)nm23-H1基因的表达低于转移低危组(P<0.05);CD44v6阳性14例,阳性率为38.9％,转移高危组表达高于转移低危组(P<0.05),包膜欠完整组表达高于包膜完整和无包膜组(P<0.05),nm23-H1基因的表达与CD44v6基因的表达有关联(P<0.05)。结论 HCC的SCT表现与相关基因的表达有关,HCC SCT表现对推测nm23-H1基因和CD44v6基因的表达有一定价值。     

螺旋CT多期增强扫描对平扫为等密度的肝细胞癌的诊断

目的 分析平扫为等密度的肝细胞癌(hepatocellular carcinoma,HCC)的螺旋CT( spiral CT,SCT)多期增强扫描表现,探讨SCT多期增强扫描对此类HCC的诊断价值.方法 收集本院经手术病理、肝穿刺活检或临床随访证实的CT平扫呈等密度的HCC 14例(占同期702例HCC的1.99%),回顾性分析这类HCC 的SCT多期增强扫描的强化方式及CT征象.结果 14例HCC 的SCT平扫均呈等密度影(假阴性).SCT多期增强扫描表现为"速升速降"型强化的4例,3例可见肿瘤假包膜形成;动脉期仍为等密度,门脉期及延迟期呈低密度影的4例;动脉期、门脉期和延迟期癌灶均呈低密度影的2例;动脉期瘤灶明显强化,门脉期、延迟期表现为等密度的3例;平扫为等密度、多期增强扫描显示动静脉瘘及门静脉癌栓的弥漫型肝细胞癌1例.结论 CT平扫可能会漏诊等密度的肝癌病灶,可疑患者需行增强扫描检查;SCT多期增强扫描能显示平扫为等密度的HCC的血供特点,对其具有重要的诊断价值.     

肝细胞性肝癌影像表现与手术预后的相关性研究

目的 探讨肝细胞性肝癌(HCC)的影像学征象与手术预后的关系,深入认识影像征象的意义,为临床设计更加合理的治疗方案提供客观依据.方法 搜集65例经手术病理证实的HCC患者资料.65例HCC患者术前都进行CT或MRI平扫及增强扫描,其影像学征象包括肿瘤包膜、大小、肿瘤血管、门静脉癌栓、肿瘤坏死、合并肝硬化、肿瘤数目(单发或多发)等情况,将上述影像征象与预后进行统计分析.结果 65例HCC手术患者,手术前行影像学扫描,发现其中有包膜43例,无包膜22例;≤3 cm 19例,＞3 cm 46例;MSCT或MRI多期增强扫描,HCC在动脉期显示肿瘤血管41例,未见肿瘤血管显示24例;门静脉癌栓15例,未见癌栓50例;肿瘤坏死51例,14例未见坏死灶;合并肝硬化16例,未见肝硬化49例;肝内出现多发结节53例,单发结节12例.65例术后随访2年,肿瘤转移或复发26例,未见转移或复发39例.HCC影像所表现的肿瘤包膜、大小、门静脉癌栓、合并肝硬化与预后的相关性差异有显著统计学意义(P＜0.05);其他征象如肿瘤血管、肿瘤坏死和肿瘤数目与预后的相关性差异无显著统计学意义(P＞0.05).结论 HCC影像表现在一定程度上可反映患者的手术预后情况,为术前指导临床制定个体化治疗或手术方案提供依据.     

肝细胞癌螺旋CT同层动态扫描表现与肿瘤血管生成的相关性

目的 探讨肝细胞癌螺旋CT同层动态扫描所获部分参数和形态学表现特征与肿瘤血管生成的相关性。方法 经病理证实的肝细胞癌26例、全肝平扫后选择靶平面行同层动态扫描和门脉期全肝扫描,评价癌灶形态表现特征、时间－密度曲线（T－DC）走势,并计算癌灶强化峰值（PV）和强化比值（CER）。组织切片经Ⅷ因子相关抗原（F8RA）和血管内皮生长因子（VEGF）免疫组化染色,分析癌组织微血管数（MVC）和癌细胞VEGF表达阳性率。将CT形态表现和所获部分参数与组织病理学改变进行比较研究。结果 癌灶PV7．9－75．2HU,CER3．8％－36．0％;MVC6－91,VEGF阳性率32％－78％。癌灶PV、CER与MVC呈显著正相关（r分别为0．508、0．423,P值分别＜0．01、0．05）,癌灶PV、CER与VEGF阳性率无显著相关性（r分别炎0．256、0．347,P值均＞0．05）;肿瘤新生血管分布影响TDC走势,肿瘤血管是否丰富及其组织结构特点影响肿瘤强化特征。结论 根据肝细胞癌螺旋CT同层动态扫描部分参数及T－DC走势和增强大体形态表现,可推测癌组织MVC和肿瘤新生血管分布特征,并可反映肿瘤血管是否丰富及肿瘤组织结构特点。     

Correlative study of angiogenesis and dynamic contrast-enhanced magnetic resonance imaging features of hepatocellular carcinoma

PURPOSE: To explore the correlation between contrast-enhancement patterns on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and angiogenesis by analyzing microvessel density (MVD), vascular endothelial growth factor (VEGF), and P53 protein expression in hepatocellular carcinoma (HCC). MATERIAL AND METHODS: MRI was performed with a GE Signa 1.5T MR scanner using SE and FMPSPGR sequences in 30 patients (38 lesions) during the period October 1998 to March 2000. All had histopathologically proven HCC. MR images were reviewed/ analyzed retrospectively. The 30 patients were between 35 and 65 years of age (average age 58; 18 M and 12 F). SE T1WI, PDWI, and T2WI were acquired initially. The FMPSPGR sequence was acquired in the same position. The DCE-MRI was performed in the arterial, portal vein, and delay phase after a bolus injection of Gd-DTPA. The specimens were stained immunohistochemically for CD34, VEGF, and P53. MVD was highlighted by anti-CD34 antibody staining. The enhancement features of HCC lesions were studied correlatively with the tumor MVD, VEGF, and P53 expression at protein level. RESULTS: In the arterial phase, the results showed that MVD of HCC in the high-enhancement group (229.76 +/- 80.96) was higher than that in the equal-enhancement (173.09 +/- 61.38) and low-enhancement groups (153.00 +/- 108.58) (P < 0.01, respectively). VEGF expression of HCC in the high-enhancement group (68.42%) was higher than that in the equal-enhancement (36.36%) and low-enhancement groups (38.89%) (P < 0.05, respectively). In the portal vein phase, MVD of HCC in the enhancement group (259.80 +/- 93.30) was higher than that in the non-enhancement group (178.64 +/- 92.65) (P < 0.05). No significant correlation was found between VEGF expression and the enhancement feature in the portal vein phase. In the delay phase, MVD of HCC in the ring-enhancement group (269.06 +/- 57.89) was significantly higher than that in the non-ring-enhancement group (144.10 +/- 88.90) (P < 0.01). There was a significant difference in VEGF expression between the ring-enhancement group (76.47%) and the non-ring-enhancement group (42.86%) (P < 0.05). No significant correlation was detected between P53 protein expression and the enhancement feature. Relative enhancement (RE) correlated with MVD, but not with VEGF and P53 protein expression. CONCLUSION: The contrast-enhancement patterns on DCE-MRI are influenced by tumor angiogenesis, as reflected by elevated VEGF expression, and are therefore valuable indicators for accessing tumor angiogenic activity and tumor neovascularization in vivo in HCC patients.     

Enhancement patterns of hepatocellular carcinomas on multiphasicmultidetector row CT: comparison with pathological differentiation

Objective The objective of this study was to determine the incidence of typical and atypical enhancement patterns of hepatocellular carcinomas (HCCs) on multiphasic multidetector row CT (MDCT) and to correlate the enhancement patterns and morphological image findings of HCC with the degree of tumour differentiation. Methods MDCT images of 217 patients with 243 surgically proven HCCs were evaluated through consensus reading by two radiologists. Our MDCT protocol was composed of precontrast, arterial, portal and delayed phases. The reviewers analysed the CT images for degree of attenuation; relative timing of washout; presence of dysmorphic intratumoral vessels, aneurysms and necrosis; tumour size; tumour margin; presence of pseudocapsule; intratumoral heterogeneity; and determined enhancement pattern. The imaging features were correlated with tumour differentiation using Fisher's exact test or the χ(2) test. Results Among 243 HCCs, 137 (56.4%) showed the typical enhancement pattern of HCC, which is arterial enhancement and washout on portal or equilibrium phase images. In the arterial phase, 190 of 243 (78.2%) HCCs showed hypervascularity, with approximately three quarters of poorly differentiated (PD) (34 of 45, 75.6%) and moderately differentiated (MD) HCCs (92 of 123, 74.8%) showing washout during the portal or delayed phases, vs only 50% of well-differentiated (WD) HCCs (11 of 22; p<0.048). The presence of intratumoral vessels and aneurysms, tumour necrosis, attenuation of precontrast, the relative timing of washout, intratumoral attenuation heterogeneity, tumour margin and tumour size were correlated with the pathological differentiation of HCCs (p<0.05). Conclusion A typical enhancement of HCCs on MDCT was not unusual (43.6%) and WD and PD HCCs account for most of the atypical enhancement patterns. Early washout favoured MD and PD HCCs rather than WD HCCs, whereas in our study the presence of intratumoral aneurysm was a highly specific finding for PD HCC.     

Multiphase contrast-enhanced CT imaging in hepatocellular carcinoma correlation with immunohistochemical angiogenic activities

RATIONALE AND OBJECTIVES: To evaluate the correlation between enhancement parameters of multiphase contrast-enhanced computed tomography (CT) and immunohistochemical activities of vascular endothelial growth factor (VEGF), VEGF receptors, and CD34 in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Twenty-seven patients underwent curative resection for HCC with no preoperative treatment. We defined several CT enhancement parameters by measuring attenuation values of tumor, liver parenchyma, and aorta. The stored tissue blocks were assayed for immunohistochemical activities of VEGF, two VEGF receptors (Flt-1, Flk-1), and CD34, which were correlated with the enhancement parameters of multiphase contrast-enhanced CT. RESULTS: The VEGF activities in HCC showed moderate positive correlation with phase difference in portal phase, delayed enhancement (DE), tumor-blood ratio, blood pool index, and tumor-parenchyma ratio in arterial phase. The Flk-1 activities in HCC showed moderate positive correlation only with DE. CD34 activity in HCC showed positive correlation with most of the CT parameters except for DE. CONCLUSION: Our study showed that several CT enhancement parameters representing mainly delayed enhancement features were well correlated with VEGF activity in HCC, and might be valuable indicators for assessing angiogenic activity in HCC.     

肝细胞癌边缘CT征象与肿块周围部VEGF表达相关性研究

 目的 研究肝细胞癌(hepatocellular carcinoma,HCC)边缘组织中血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达水平与螺旋CT增强扫描表现,探讨癌灶边缘强化程度与VEGF表达之间的关系.方法 经外科手术切除、病理证实的HCC患者48例,术前进行全肝平扫与双期增强扫描,观察肿块边缘CT表现与病理特征,分析包膜有无、包膜完整性及肿瘤的强化程度与VEGF表达之间的关系.采用VEGF免疫组织化学检测手术标本肿瘤边缘区不同方位点VEGF表达阳性细胞百分比.结果 CT显示包膜的有无及完整性与手术病理一致,包膜完整、境界清楚10例(10/48,20.83%),肿块无明确包膜17例(17/48,35.42%),境界均显示不清,包膜不完整、境界部分不清楚21例(21/48,43.75%);肿块周边不同方位点VEGF表达阳性率完全一致14例(14/48,29.2%),平均阳性率为(53.09±11.72)%,动脉期肿块周边组织CT强化程度(28.13±10.20) Hu;肿块周边不同方位点VEGF表达阳性率不一致34例(34/48,70.8%),平均阳性率为(78.24±14.73)%,动脉期肿块周边组织CT强化程度(57.25±12.83) Hu.结论 CT扫描能较好的反映肿瘤包膜的完整程度,肿瘤边缘区有包膜与无包膜其VEGF表达水平有明显差异(P<0.05);肿块边缘强化程度与肿瘤边缘区VEGF表达水平呈正相关关系(P<0.01).HCC肿瘤边缘区VEGF表达水平与HCC的边缘CT表现有关,一定程度上反映了肿瘤的病理特征和生物学行为.     

"慢进快出"型肝细胞肝癌的CT诊断

目的研究慢进快出型肝细胞肝癌(hepatocellular carcinoma,HCC)螺旋CT(SCT)检查价值。资料与方法分析经手术病理证实的50例HCC的CT表现。结果50例中18例SCT增强扫描表现为慢进快出型,动脉期病灶强化,门静脉期病灶密度不下降,反而进一步升高,延迟期强化密度迅速下降。结论SCT增强扫描呈慢进快出型表现与其肝动脉和门静脉的双重血供有关,似与肿瘤分化程度不相关。     

肾细胞癌的螺旋CT表现及与病理间的关系

目的　探讨肾细胞癌(RCC)的螺旋CT(SCT)表现及与病理间的关系。资料与方法　搜集行SCT检查并经手术病理证实的RCC 34例,将SCT征象分组与病理征象进行比较。结果　(1) 34例RCC增强后均有显著强化,其中2 6例肿瘤在皮髓期密度等于或超过肾皮质,8例低于肾皮质高于肾髓质;SCT双期增强扫描对34例RCC的检出率为10 0 % ,定性诊断率为10 0 % ,分期的准确性为94 %。(2 )SCT上肿瘤边缘清晰者14例,病理检查12例有完整的假包膜(85 .7% ) ;细胞核分级在瘤体直径>3.0cm组、肿瘤边缘不清晰组、瘤体中心有坏死不强化区组,分别高于瘤体直径≤3.0cm组、肿瘤边缘清晰组、瘤体内无坏死区组(P均<0 .0 1)。结论　SCT双期增强扫描是RCC可靠的检查方法,能准确反映其病理学基础。     

Evaluation of pathological features of hepatocellular carcinoma by contrast-enhanced ultrasonography: comparison with pathology on resected specimen

Features of hepatocellular carcinoma (HCC) observed by contrast-enhanced ultrasonography (CEUS) were compared to pathological features of corresponding resected HCC specimens, to evaluate the ability of CEUS to depict the pathological features of HCC. We investigated 50 HCC nodules that were treated by surgical resection. All nodules had been examined by CEUS with intravenous contrast agent (Levovist) before surgery. CEUS findings were divided into three phases for evaluation and classification of enhancement patterns: two vascular phases (arterial phase and portal venous phase) and the delayed phase. Pathological examination focused on differentiation and on the presence or absence of a tumor capsule, intratumoral septum, and intratumoral necrosis. All 21 nodules that showed a linear or annular vessel around the tumor margin in the arterial phase had capsular formation. Of the 27 nodules that showed heterogeneous perfusion in the portal venous phase, 21 (77.8%) had an intratumoral septum and 23 (85.2%) showed intratumoral necrosis. All nodules that were depicted as a defect with an unclear margin in the delayed phase were well-differentiated HCCs, whereas all nodules that were depicted as a defect with a clear margin were moderately or poorly differentiated HCCs. From our observations, the arterial, portal venous, and delayed phases of CEUS could reflect different pathological aspects of HCC. Some pathological characteristics of HCC might be evaluated preoperatively and non-invasively, by means of combined analysis of three phases of CEUS findings.