超声造影LI-RADS分类标准对混合型肝癌诊断价值的初步探讨

目的回顾性分析混合型肝癌(cHCC-CC)的超声造影(CEUS)表现,并对CEUS肝脏影像和报告系统(LI-RADS)判定cHCC-CC分类的价值进行初步探讨。方法经病理诊断为cHCC-CC且具备CEUS检查结果的44例患者为研究对象。总结cHCC-CC的CEUS表现,并依据CEUS LI-RADS (2017版)对局灶性肝脏病变进行分类,其中LR-5为明确诊断HCC,LR-M为非HCC的肝内恶性病灶。结果 cHCC-CC CEUS动脉期31灶(70.5%)呈高增强,11灶(25%)呈周边环状强化,2灶(4.5%)呈等增强;平均开始廓清时间为(67.3±48.4)s,其中30灶(68.1%)60s内廓清,9灶(20.5%)61～120s内廓清,5灶(11.4%)>120s廓清。34灶判定为LR-M,8灶为LR-5,2灶为LR-4。判定为LR-5的8灶中有1例患者单独CA-199升高,2例患者AFP和CA-199同时升高,1例胆管扩张;6例患者动脉期强化不均匀,1例患者病灶强化范围边界不清。结论 cHCC-CC的CEUS模式可呈高增强和周边环状强化,部分病灶LR-RADAS有被判定为HCC的可能,需结合其他征象综合判断。

Preliminary Study on the Diagnostic Value of Contrast Enhanced Ultrasound LI-RADS for Combined Hepatocellular Cholangiocarcinoma

Objective To retrospectively analyze the contrast-enhanced ultrasound(CEUS)performance of combined hepatocellular cholangiocarcinoma(cHCC-CC)and to explore the value of CEUS Liver Imaging Reporting and Data System(LI-RADS)of the cHCC-CC classification.Methods 44 patients with pathological diagnosis of cHCCCC and CEUS results were enrolled in the analysis.The CEUS performances of cHCC-CC were summarized and focal liver lesions were classified according to CEUS LI-RADS(2017 version),in which LR-5 is a definitive diagnosis of HCC,LR-M is a non-HCC malignant lesion.Results 31 cHCC-CC lesions(70.5%)in the arterial phase of CEUS showed hyperenhancement,11 lesions(25%)showed rim peripheral enhancement,and 2 lesions(4.5%)showed isoenhancement;the average starting washout time was(67.3±48.4)s,of which 30 lesions(68.1%)washed out within60 s,9 lesions(20.5%)washed out between 61-120 s,and 5(11.4%)washed out after 120 s.Thirty-four lesions were judged as LR-M,8 lesions were LR-5,and 2 lesions were LR-4.Among 8 patients of LR-5,one had elevated CA-199 alone,2 patients had both elevated AFP and CA-199,One had bile duct dilatation;6 lesions enhanced heterogeneously during arterial phase,1 lesion was with unclear border during enhancement.Conclusions The CEUS patterns of cHCC-CC can be hyperenhancement and rim peripheral enhancement.Some lesions have the possibility of being judged as HCC according to CEUS LI-RADS,which needs to be compressive diagnosis combined with additional features.