超声造影微血管成像技术评价肝细胞性肝癌微血管构筑及病理相关

目的评价微血管造影成像（micro flow imaging，MFI）对肝细胞性肝癌（HCC）微血管构筑的显示，探讨HCC血管构筑与病理分化程度的关系。方法对37例病理确诊的HCC超声造影，造影剂为声诺维，成像方法为常规对比谐波成像（contrast harmonic imaging，CHI）以及MFI。观察2种成像方法对肿瘤内微血管的显示效果、微血管的形态及其与肿瘤病理分化的关系。组织病理诊断按Edmonson法分类。结果37个病灶在CHI均为动脉期高增强、门脉期及延迟期低增强，动脉期肿瘤血管显示率为54．05％。MFI清晰显示全部病灶微血管构筑，形态分为3型：棉花型12（32．4％）、灌木型22（59．5％）、枯枝型3（8．1％）。肿瘤微血管构筑与病理分化程度相关：75．0％（3／4）EdmonsonⅠ级HCC表现为棉花型，75．0％（18／24）EdmonsonⅡHCC表现为灌木型，而枯枝型只见于EdmonsonⅢ、Ⅳ级HCC。结论MFI可敏感地显示HCC微血管构筑。HCC肿瘤微血管构筑与病理分化程度相关。

Evaluation of Micro Vascular Architecture of Hepatocellular Carcinoma Using Micro Flow Imaging: Correlation with Pathology

Objective To evaluate the value of contrast-enhanced ultrasound micro flow imaging(MFI) in depicting the micro vascular architecture of hepatocellular carcinoma(HCC) and the correlation with pathological differentiation.Methods Thirty seven patients with HCC underwent contrast harmonic imaging(CHI) and MFI.A sulphur hexafluoride-filled microbubble contrast agent SonoVue was used.The capability of CHI and MFI in depicting the intratumoral vessels was evaluated.The relationship between pathological differentiation and vascular patterns on MFI was also analyzed.Results All 37 HCC showed hyper-enhancement in arterial phase and hypo-enhancment in portal and late phase on CHI,and intratumoral vessels were depicted in twenty(54.05%) of them.On MFI,the tumor vascular architectures in all lesions were clearly delineated and were divided into three patterns:cotton pattern in 12(32.4%),shrubbery pattern in 22(59.5%) and deadwood pattern in 3(8.1%).The relationship between pathological differentiation of HCC and vascular pattern was independent(p=0.006).Cotton pattern were present in 75.0%(3/4) of Edmonson grade I HCCs,shrubbery pattern in 75.0%(18/24) of Edmonson grade II HCCs,whereas deadwood pattern was only seen in Edmonson grade III and IV HCCs.Conclusions MFI technique is more sensitive in depicting vascular architecture in HCC,and the vascular architecture pattern correlates with pathological differentiation.