不同分化程度、不同病理类型小肝癌患者超声造影表现分析

目的 分析不同分化程度、不同病理类型小肝癌(SHCC)患者超声造影表现,探讨超声造影判断SHCC分化程度和病理类型的价值.方法 回顾性分析经手术病理证实的70例SHCC患者83个病灶超声造影表现.其中59例患者1个病灶,9例患者2个病灶,2例患者3个病灶.83个病灶中高分化42个,中分化31个,低分化10个;梁索型54个,假腺管型15个,实体型10个,纤维硬化型4个.结果 不同分化程度SHCC超声造影呈"快进快出"增强模式占75.90%(63/83).高、中、低分化程度SHCC病灶造影剂开始增强时间分别为(14.02±3.89)、(13.27±2.35)、(12.84±2.28)s,达峰时间分别为(29.23±10.01)、(28.02±13.75)、(26.47±12.25)s,消退时间分别为(99.96±34.13)、(73.28±28.54)、(41.34±9.55)s.随着SHCC分化程度的降低,造影剂开始增强时间、达峰时间和消退时间均缩短,且不同分化程度肿瘤病灶造影剂开始增强时间和达峰时间的差异均无统计学意义(χ2=4.035、5.798,P均>0.05),但造影剂消退时间的差异有统计学意义(χ2=63.930,P<0.01).不同分化程度SHCC患者造影剂动脉相增强模式差异无统计学意义(χ2=0.134,P>0.05),门脉相、延迟相增强模式差异有统计学意义(χ2=8.232、14.570,P均<0.05).进一步两两比较,高分化与中分化、高分化与低分化、中分化与低分化SHCC患者造影剂门脉相、延迟相增强模式差异均有统计学意义(门脉相:χ2=6.610、5.281、5.453,P均<0.05;延迟相:χ2=9.432、7.128、5.279,P均<0.05).不同病理类型SHCC患者造影剂动脉相增强模式差异无统计学意义(χ2=2.120,P>0.05),门脉相、延迟相增强模式差异有统计学意义(χ2=16.420、17.390,P均<0.01).进一步两两比较,梁索型与实体型、梁索型与纤维硬化型、假腺管型与实体型、假腺管型与纤维硬化型、实体型与纤维硬化型SHCC患者造影剂门脉相、延迟相增强模式差异均有统计学意义(门脉相:χ2=5.277、9.146、5.333、6.761、13.001,P均<0.05;延迟相:χ2=3.919、9.429、4.000、10.950、11.974,P均<0.05).结论 不同分化程度、不同病理类型SHCC超声造影表现特征存在差异,超声造影对判断SHCC分化程度和病理类型具有重要的参考价值.

Contrast-enhanced ultrasound analysis of different differentiation degree and pathological types ofsmall hepatocellular carcinoma

Objective To analyze and evaluate the value oi contrast-enhanced ultrasouna（CEUS）in estimating the differentiation degree and pathological features of small hepatocellular carcinoma （SHCC）. Methods All 70 cases of SHCC with 83 lesions examined by CEUS were retrospectively analyzed. Of all the cases,59 with 1 lesion, 9 with 2 lesions, 2 with 3 lesions. Forty-two, thirty-one and ten lesions were pathologically diagnosed as high, medium and low differentiation;the pathological types were classified to：trabecular type（54） ,glandular type（15） ,compact type（10） ,cirrhotic type（4）. Results ＂Fast wash-in and fast wash-out ＂, enhancement pattern was accounted for 75. 90% （63/83） in all the SHCC cases of differentiation degrees. The enhancement time in high, medium and low differentiation lesions were respectively （14.02±3.89）、（13.27±2.35）、（12.84±2.28） s ; time to peak were respectively （29.234-10.01）、（28.02±13.75）、（26.47±12.25）s;and the washout time were respectively（99.96±34.13）、（73.28±28.54）、（41.34±9.55）s. In lower SHCC differentiation degree, time to begin washout, time to peak and the washout time were shorter. The differences of enhance time and peak time in different degree of differentiation were not statistically significant （X^2=4.035、5.798,all P〉0.05）, but the difference ofwashout time was statistically significant（X^2 = 63. 9296 ,P 〈 0.01 ）. The differences of enhancement pattern in arterial phase were not statistically significant （X^2 = 0. 134, P 〉 O. 05 ） in the different degree of differentiation lesions ,but that in portal phase and late phase were statistically significant （X^2 = 8.2315,14. 570, all P 〈 0.05 ）. For a further two-two comparison, the differences of enhancement pattern between high and medium differentiation lesions, high and low differentiation lesions, medium and low differentiation lesions were statistically significant in portal phase and late phase（portal phase ：X^2 =6. 610,5. 281,5. 453 ,all P 〈0.05; late phase ：X^2 = 9. 432,7. 1284,5. 279, all P 〈 0.05 ）. In patients with different pathological tvoes of SHCC. thedifferences of enhancement pattern in arterial phase were not statistically significant （X^2 = 2. 120, P 〉 0.05 ）, slgmficant（X^2 16.42,17.39,all P 〈0.01 ）. For a and that in portal phase and late phase were statistically significant（X^2 further two-two comparison, the differences of enhancement pattern between trabecular and compact type lesions, trabecular and cirrhotic type lesions, glandular and compact type lesions, glandular and cirrhotic type lesions, compact and cirrhotic type lesions, were statistically significant in the portal phase and late phase （portal phase ：X2 = 5. 277,9. 146,5. 333,6. 761,13. 001, all P 〈 0.05 ; late phase ：）（2 = 3. 919,9. 429, 4.000,10. 950, 11. 974, all P 〈 0.05 ）. Conclusion CEUS is important to determine the differentiation degree and pathological types of SHCC.