肝内胆管细胞癌超声造影增强模式及肝背景的影响

目的探讨肝内胆管细胞癌(ICC)的实时超声造影(CEUS)增强模式及肝炎肝硬化背景对肝内胆管细胞癌增强模式的影响。方法回顾性分析经病理证实的肝内胆管细胞癌患者67例(67个病灶),其中22例合并慢性乙型肝炎(含13例乙肝相关性肝硬化)。手术切除前(57例)或穿刺前(10例)均经超声造影检查,记录分析病灶的超声表现及超声造影增强模式。结果超声显示乙肝相关性肝硬化患者中有2例(2/13,15.4%)可见胆管扩张,非肝硬化患者合并胆管扩张25例(25/54,46.3%),二者差异有统计学意义(P<0.05)。超声造影显示肝内胆管细胞癌动脉期有60灶(89.6%)为高增强,4灶等增强,3灶低增强;其中36灶(53.7%)为周边增强,31灶(46.3%)为整体增强。肝硬化背景下肝内胆管细胞癌中动脉期表现为周边增强者(3/13灶,23.1%)亦明显低于非肝硬化背景下胆管细胞癌(32/54灶,57.1%)(P<0.05)。所有病灶均可见造影剂廓清,平均开始廓清时间为38s (20~101s)。有无合并肝炎或肝硬化的病灶廓清时间无明显差异(P>0.05)。结论乙肝相关性肝硬化背景下肝内胆管细胞癌超声造影增强模式不同于非肝硬化背景下肝内胆管细胞癌。

Intrahepatic Cholangiocarcinoma:Contrast-enhanced Ultrasound Appearance and Influence of Liver Background

Objective To analyze the appearance of intrahepatic cholangiocarcinoma(ICC)on contrast enhanced Ultrasound(CEUS)and the influence of hepatitis B-associated hepatitis and cirrhosis on the enhancement modes.Methods From 67 patients with 67 pathology confirmed intrahepatic cholangiocarcinoma were retrospectively analyzed.22 patients had hepatitis B(including 13 patients with hepatitis B-related cirrhosis).All patients underwent CEUS before surgery(n=57)or biopsy(n=10).Results On baseline ultrasound,patients without cirrhosis showed higher incidence of intrahepatic bile duct dilation(46.3%,25/54)than patients with cirrhosis(15.4%,2/13)(P<0.05).On CEUS,60 lesions(89.6%)showed hyper-enhancement,4 iso-enhancement and 3 hypo-enhancement.36(53.7%)lesions showed peripheral enhancement and 31 diffuse enhancement.Fewer lesions(3/13,23.1%)showed peripheral enhancement in patients with cirrhosis than in patients without cirrhosis(32/54,57.1%)(P<0.05).All lesions washed out with the mean wash-out start time of 38 second(20-101 second).There was no difference of the wash-out start time between lesions with or without hepatitis or cirrhosis(P>0.05).Conclusions There was significantly different appearance of ICC between patients with or without hepatitis B-related cirrhosis on ultrasonography and contrast enhanced ultrasound.