肝细胞腺瘤的临床及超声特点分析  

Clinical and contrast-enhanced ultrasound characteristics of hepatocellular adenoma

作　　者：邹旻红[1] 林伟珍 黄庆 蒋叶 张娈景 郑荣琴[1] Minhong Zou;Qing Huang;Ye Jiang;Luanjing Zhuang;Rongqin Zheng(Department of Ultrasound,the Third Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510630,China;Department of Pathology,the Third Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510630,China;Department of Gastrointestinal Surgery,Guangzhou First People's Hospital(The Second Affiliated Hospital of South China University of Technology),Guangzhou 510013,China)

机构地区：[1]中山大学附属第三医院超声科,广州510630 [2]中山大学附属第三医院病理科,广州510630 [3]广州市第一人民医院(华南理工大学附属第二医院)胃肠外科,510013

出　　处：《中华医学超声杂志（电子版）》2022年第11期1225-1231,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：广东省医学科学技术研究基金项目(A2019526);广州市科技计划项目(202102010024)

摘　　要：目的探讨肝细胞腺瘤(HCA)临床和超声特点,提高HCA的临床诊断能力。方法回顾性分析2008年1月至2021年5月中山大学附属第三医院经病理证实的10例HCA患者(HCA组)、17例经典型肝血管平滑肌脂肪瘤患者(CMAL组)和同时期随机检索的40例甲胎蛋白阴性的肝细胞癌患者[HCC(AFP-)组]的临床、影像及病理资料,采用t检验和χ^(2)检验分别比较HCA组与CMAL组、HCC(AFP-)组临床特点、二维超声和超声造影表现的差异。结果HCA组患者发病年龄为(36.40±16.68)岁,与HCC(AFP-)组患者在性别(男/女:5/5vs36/4)、肝炎病毒感染(是/否:0/10vs40/0)等方面比较,差异均有统计学意义(χ^(2)=8.672,P=0.010;χ^(2)=50.000,P<0.001),而与CAML组差异无统计学意义(P均>0.05)。HCA组病灶回声不具有特异性,HCC(AFP-)组二维超声多表现为低回声,2组间差异具有统计学意义(χ^(2)=8.404,P=0.011),而病灶数目、大小、形态及血供方面比较,2组差异均无统计学意义(P均>0.05);HCA与CAML组间病灶数目、大小、边界、回声、形态及血供差异均无统计学意义(P均>0.05)。HCA病灶超声造影增强模式主要表现为“高-等-等”,HCC(AFP-)组病灶超声造影增强模式表现为“高-低-低”,CAML组病灶超声造影增强模式表现为“高-高-等或高-等-等”。HCA组与CAML组间超声造影表现差异无统计学意义(P>0.05);HCA组与HCC(AFP-)组间门静脉期(高/等/低:1/6/3vs0/4/36)及延迟期(高/等/低:0/6/4vs0/1/39)增强表现比较,差异具有统计学意义(χ^(2)=15.106,P<0.001;χ^(2)=12.500,P=0.002),而动脉期增强表现差异无统计学意义(P均>0.05)。结论HCA具有一定的临床、常规二维超声和超声造影表现特点,对于女性、无乙肝感染、超声造影表现“高-等-等”的肝内占位性病变,应注意HCA的可能。ObjectiveTo summarize the clinical and ultrasound characteristics of hepatocellular adenoma to improve its diagnosis.MethodsThe clinical,imaging,and pathological data of 10 patients with hepatic adenoma(HCA group),17 patients with hepatic angiomyolipoma(CMAL group),and 40 randomly selected AFP negative hepatocellular carcinoma patients(HCC(AFP-)group)diagnosed at the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to May 2021 were retrospectively reviewed.Thet-test and chi-square test were used to compare the clinical characteristics and ultrasound and contrast-enhanced ultrasound findings in the three groups.ResultsThe average age of onset in the HCA group was(36.40±16.68)years old.The gender(male/female:5/5vs36/4)and hepatitis virus infection status(yes/no:0/10vs40/0)of the patients in the HCA group(yes/no:0/10vs40/0)were statistically different from those of the HCC(AFP-)group(χ^(2)=8.672,P=0.010;χ^(2)=50.000,P<0.001),but showed no statistical difference from those of the CAML group(P>0.05 for all).There were statistically significant differences in tumor echo between the HCA(unspecific tumor echo)and HCC(AFP-)(mostly hypoechoic)groups(χ^(2)=8.404,P=0.011),though there was no significant difference in tumor number,size,morphology,or blood supply(P>0.05 for all).There was also no significant difference in tumor number,size,boundary,echo,morphology,or blood supply of lesions between the HCA and CAML groups(P>0.05 for all).The CEUS pattern was mainly"hyperintense-isointense-isointense"for HCA lesions,"hyperintense-hypointense-hypointense"for HCC(AFP-)lesions,and"hyperintense-hyperintense-isointense"or"hyperintense-isointense-isointense"for CAML lesions.The CEUS pattern between the HCA group and the CAML group was not statistically different.There was a statistically significant difference in the enhancement patter in the portal phase(hyperintense/isointense/hypointense:1/6/3vs0/4/36;χ^(2)=15.106,P<0.001)and the delayed phase(hyperintense/isointense/hypointense:0/6/4vs0/1/39;χ^(2)=12.50

关 键 词：肝细胞腺瘤 肝血管平滑肌脂肪瘤 肝细胞癌 超声 超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]