肝细胞癌分化程度、病灶大小及肝病背景对超声造影廓清过程的影响  

Washout of hepatocellular carcinoma in contrast-enhanced ultrasound: the influence of the degree of cellular differentiation, the tumor size and the background of liver

作　　者：杨丹[1] 李锐[1] 郭燕丽[1] 唐春霖[1] 陈朝晖[1] 

机构地区：[1]第三军医大学西南医院超声科,重庆400038

出　　处：《中华医学超声杂志（电子版）》2016年第4期286-292,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨分化程度、病灶大小、肝病背景对肝细胞癌（HCC）超声造影廓清过程的影响。方法回顾性分析2005年1月至2015年6月第三军医大学西南医院行超声造影检查动脉相呈均匀或不均匀高增强并经手术标本或穿刺活检病理证实的HCC患者403例。所有病例均为单发病灶。将肿瘤廓清的模式分为动脉相、门脉相、延迟相开始廓清及不廓清。其中高、中、低分化HCC分别为115、156、132例;常规超声测得肿瘤最大径≤3.0 cm、3.1~5.0 cm、〉5.0 cm分别为116、154、133例;肝硬化239例,非肝硬化164例。采用R×C表的χ~2检验比较不同分化程度、不同大小HCC各廓清模式所占比例差异,进一步组间两两比较采用Pearsonχ~2检验;采用Pearsonχ~2检验比较不同肝病背景HCC各廓清模式所占比例差异。结果 403例HCC患者,不同分化程度的HCC在动脉相开始廓清的比例差异无统计学意义。高分化组HCC在门脉相开始廓清的比例均低于中分化组、低分化组HCC,高分化组HCC延迟相开始廓清、不廓清的比例均高于中分化组、低分化组HCC,且差异均有统计学意义（门脉相：χ~2=10.358、43.789,P均〈0.01;延迟相：χ2=5.134、P〈0.05,χ2=13.069、P〈0.01;不廓清：χ~2=8.669、25.899,P均〈0.01）。中分化组HCC在门脉相开始廓清的比例低于低分化组HCC,不廓清的比例高于低分化组HCC,且差异均有统计学意义（门脉相：χ~2=8.847;不廓清：χ~2=7.396,P均〈0.01）;但是中分化组HCC与低分化组HCC在延迟相开始廓清的比例差异无统计学意义。不同大小的HCC在动脉相、门脉相、延迟相开始廓清及不廓清的比例差异均无统计学意义。肝硬化背景与非肝硬化背景HCC在动脉相、门脉相、延迟相开始廓清及不廓清的比例差异均无统计学意义。结论肝病背景及病灶大小对HCC超声造影开始廓清的时相无明显影响,不同分化程度HCC超声造影开始廓清的时相具有Objective To investigate the influence of the cellular differentiation, the tumor size and the hepatic background on the washout of hepatocellular carcinoma（HCC） in contrast-enhanced ultrasound（CEUS）. Methods All 403 cases of single HCC with arterial hyperenhancement（homogeneous or heterogeneous） who underwent CEUS examination in Southwest Hospital Affiliated to Third Military Medical University and were pathologically demonstrated as HCC by surgery or needle biopsy from January 2005 to June 2015 were retrospectively enrolled. Four washout patterns were classified according to the start time of washout： washout in arterial phase, washout in portal phase, washout in delayed phase and no washout. According to the cellular differentiation, the patients were grouped as well differentiated HCCs（n=115）, moderately differentiated HCCs（n=156） and poorly differentiated HCCs（n=132）. Based on the tumor size measured by ultrasound, the patients were divided into three groups： ≤ 3 cm（n=116）, 3.1-5 cm（n=154） and 〉5 cm（n=133）. On the basis of pathology, the background of liver were divided into cirrhosis（n=239） and non-cirrhosis（n=164）. R×C table χ～2 test was used to analyze the proportion of different washout patterns among different cellular differentiation groups or different tumor size groups, and Pearson χ～2 test was used in the further two-two comparison among groups. Pearson χ～2 test was used to analyze the percentage of four washout patterns between cirrhosis and non-cirrhosis groups. Results Of 403 cases, the percentage of initial washout occurring in arterial phase was not significantly different among different cellular differentiation HCCs. Well differentiated HCCs had significantly lower percentage of washout firstly emerging in portal phase and significantly higher percentage of washout firstly emerging in delayed phase or no washout when compared with moderately or poorly differentiated HCCs（portal phase： χ2=10.358 and 47.398, both P〈 0.01; dela

关 键 词：肝肿瘤 超声检查 造影剂 廓清 

分 类 号：R445.1[医药卫生—影像医学与核医学]