神经内分泌肿瘤肝转移超声造影表现与分化程度的关系初探  

Preliminary study on the relationship between the contrast-enhanced ultrasonography of liver metastasis and the differentiation degree of neuroendocrine tumors

作　　者：尹珊珊[1] 姜彬彬[1] 崔秋丽[1] 范智慧[1] 吴薇[1] 戴莹[1] 杨薇[1] 严昆[1] Yin Shanshan;J iang Binbin;Cui Qiuli;Fan Zhihui;Wu Wei;Dai Ying;Yang Wei;Yan Kun(Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education),Department of Ultrasound,Peking University Cancer Hospital & Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所超声科、恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华超声影像学杂志》2019年第2期108-113,共6页Chinese Journal of Ultrasonography

基　　金：北京市科学技术委员会资助(Z151100004015186);国家重点研发计划(2017YFC0107303).

摘　　要：目的回顾性分析神经内分泌肿瘤(neuroendocrine tumors,NETs)肝转移的超声造影表现,初步探讨超声造影参数与肿瘤分化程度的关系。方法选取2014年1月至2018年6月已行超声造影检查且经手术或穿刺病理诊断肝内病灶为NETs转移,并进行免疫组化染色或已具有原发灶免疫组化结果的36例患者为分析对象。总结NETs肝转移灶超声造影表现,并依据病理Ki-67指数分为>20%组及≤20%组,依据嗜铬素A(CgA)分为阴性组和阳性组,依据G分期分为G1+G2组和G3组,分别比较上述分组之间NETs肝转移灶超声造影参数的差异。结果36个病灶超声造影动脉期66.7%(24/36)呈高增强,16.7%(6/36)呈等增强,13.9%(5/36)呈环状强化,5.6%(2/36)呈低增强;门脉期13.9%(5/36)呈等或高增强,86.1%(31/36)呈低增强;平均开始廓清时间为(67.5±56.1)s,其中有5个(13.9%)病灶在120s之后廓清。CgA阴性组与阳性组平均开始廓清时间相比,差异具有统计学意义[(91.6±81.5)s对(60.1±38.7)s,P=0.001]。而Ki-67≤20%组与>20%组间,G1+G2组与G3组间,所有超声造影观察指标比较差异均无统计学意义(P>0.05)。结论NETs肝转移超声造影表现具有一定特征性,其中高增强是其主要增强模式,部分病灶廓清时间较晚,但与分化程度是否有关还有待进一步探讨。Objective To retrospectively analyze contrast-enhanced ultrasound (CEUS) manifestations of neuroendocrine tumors (NETs) liver metastases, and explore the relationship between CEUS parameters and differentiation of NETs. Methods From January 2014 to June 2018, 36 patients who had been performed CEUS due to liver metastasis of NETs with pathological diagnosis and immunohistochemical staining results were enrolled in this study. The CEUS findings of NETs liver metastases were summarized. According to the Ki-67 index, CgA results, and the stage G, the patients were divided into Ki-67>20% group and Ki-67≤20% group, CgA negative group and CgA positive group, and group G1+ G2 and group G3, respectively. The CEUS parameters of NETs liver metastases between the above groups were compared. Results In 36 lesions, during the arterial phase of CEUS, 66.7% (24/36) showed hyperenhancement, 16.7% (6/36) isoenhancement, 13.9% (5/36) rim-like enhancement, and 5.6% (2/36) hypoenhancement;During the portal phase, 13.9% (5/36) showed hyper or iso enhancement, 86.1% (31/36) showed hypoenhancement. The average washout time was (67.5±56.1)s, of which 5 (13.9%) lesions were washed out after 120 s. The mean starting washout time was statistically different between the CgA negative group and the positive group [(91.6±81.5)s vs (60.1±38.7)s, P=0.001]. There was no statistically significant difference in all observations between the group of Ki-67≤20% and >20%, group G1+ G2 and group G3(P>0.05). Conclusions CEUS of NETs liver metastasis has certain characteristics, among which hyperenhancement is its main enhancement mode, and some lesions have a longer wash out time. The relationship with the degree of differentiation needs further investigation.

关 键 词：超声检查 超声造影 神经内分泌肿瘤 分化程度 

分 类 号：R445.1[医药卫生—影像医学与核医学]